NEMA 2012 Annual Dinner Registration Form

Deadline January 31, 2012

($5 Late fee if reservation made after February 1)

Print this page, fill it out, and mail with your check to address below.

Number of Adult Reservations x $45 = $
Number of Children Under 10 x $25 = $
Your Name
Guest Names
Address
City/State/Zip:
Email
Check Enclosed for $
Print this form, fill it out, and mail with your check payable to NEMA to: NEMA Attention: Michael Lipton ~ 11 Rocky Pasture Rd ~ Gloucester, MA 01930