Name _____________________________________ Meeting _________________
Address _____________________________________________________________
City _______________________________ State _______________ Zip _________
Home phone ________________________ Work phone _______________________
E-mail address ________________________________________________________
Meal Reservations: (Enclose check payable to Northeastern Regional Meeting)
| _______ | Saturday lunch | @ $8.50 | $ __________ |
| ________ | Children 4-12 | @ $ 4.00 | __________ |
| _______ | Saturday dinner | @ $13.25 | __________ |
| ________ | Children 4-12 | @ $ 6.00 | __________ |
| _______ | Sunday Lunch (potluck) | ||
| _______ | Voluntary registration | @ $10.00 | $ __________ |
| Total enclosed | $ __________ | ||
Special Needs (check all that apply)
Vegetarian ______ Smoker ______ Allergies ______ Stairs a problem ______ Other ___________________
| Childcare Needs: | Name _______________________________ Age __________ |
| Name _______________________________ Age __________ |
Please return form no later than March 16 to:
Anita Paul, 22 Bruce St., Scotia NY 12302