---------- Print this page and mail with your check ----------
AMC CT Chapter
Annual
Gathering Reservation Form
Saturday, November 20, 2010
| Dinner and Evening Program | |
| AMC Members | $40.00 |
| Non-Members | $45.00 |
| Workshops Only | $10.00 |
|
Dinner Choices |
|
| Grilled Salmon Scampi | Served with Vegetable Medley and Garlic Mashed Potatoes |
| Chicken Marsala Mushroom | |
| Grilled Flat Iron Steak | |
| Vegetable Lasagna Roulade | |
| First and Last Name | AMC Member # | Meal Choice | Amount Enclosed | |
| 1. | ||||
| 2. | ||||
| 3. | ||||
| Total payable to "AMC CT CHAPTER" | ||||
No confirmation is sent. Pick up your name badge at the Registration Table. This is your admission and dinner ticket.
| Dinner Price Includes Evening Program | Mail this form with your check to: | |
Your Phone #______________________________ Your Email Address_________________________ |
David Bellemare 91 Kendall Cir Waterbury, CT 06708 |
|