Complete the credit card information below and return this form via fax to ... for this event, we request that you also
Registration Form Annual MALSCE Board of Directors Meeting & Dinner Thursday, September 20, 2012 Holiday Inn Mansfield/Foxborough, Mansfield MA 02048 5:30 - 6:30 PM Registration/Reception; 6:30 - 9:00 PM MALSCE Board of Government Meeting/Dinner
Registrant Information: Name: Firm: Address: City: State: Tel: Email: Dietary Restrictions:
Registration Fees:
Zip:
(please describe)
Thursday’s Board Meeting and Dinner
MALSCE Member – $40 Non MALSCE Member – $50
Entrée Selection: Please indicate your dinner selection by checking the box below
Chicken Cordon Bleu
Boston Scrod
Payment: (Check payment method) Credit Card: Complete the credit card information below and return this form via fax to 617/227-6783 or by email to
[email protected].
Visa
MasterCard
Amex
Card Name: Card Number: Billing Address: Expiration Date: Signature: Check: Make checks payable to “MALSCE” and mail with this form to MALSCE, The Engineering Center, One Walnut Street, Boston, MA 02108-3616. To ensure your timely registration for this event, we request that you also send this form via fax or email to 617/2276783 or
[email protected], respectively.
Registration Deadline: Monday, September 17, 2012 Cancellations received after September 17, 2012 and no-shows will be billed. Space is limited, so register now.
