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        MTSMA REGISTRATION FORM  2010   | 
    
      | Name(s) 1________________________________ 2___________________________________ Institution(s) 1_____________________________ 2___________________________________ Email Address(es) 1_________________________    2_________________________________ Mailing Address(es) 1____________________________________________________________________________
 2____________________________________________________________________________ Banquet, Friday, March 26, 6:00 p.m. ($25 per person)Deans Hall, Penn Stater Conference Center Hotel
 
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      |  | How many?   _____      Total:  $ ______ | 
    
      | If you will attend the banquet, please choose one of the following: chicken _______                        fish _______                        vegetarian _______ | 
    
      | Luncheon, Saturday, March 27, 11:45 a.m. ($10 per person)
 Zoller Café, Visual Arts Building, Penn State University
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      |  | How many?   _____     Total:  $ ______ | 
    
      | If you will attend the luncheon, please choose one of the following boxed lunches: roast turkey and provolone sandwich _______roast beef and cheddar sandwich _______
 Thai curry chicken wrap _______
 Asian vegetable wrap _______
 (All boxed lunches include one side salad, a bag of chips, two cookies, and a bottled water or can of Pepsi.)   | 
    
      | The Penn Stater Hotel will provide complimentary shuttle service from the hotel to the Penn State campus on Saturday, March 27th. Please let us know if you would like to use this service: Yes _______                                                No _______   | 
    
      | Registration (There are no dues. Automatic membership is by attendance or by e-mailing a request to Vincent Benitez at: vpb2@psu.edu) $50 if postmarked by March 15; $60 after that or at the door** | 
    
      |  | How many?  ______      Total:  $ ______ | 
    
      | $15 (for retired people, students, and those not presently employed) | 
    
      |  | How many?  ______      Total:  $ ______ | 
    
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      |  |  | Grand Total: $_______ | 
    
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      | **Those who mail this registration form by March 15th will be included on the list of pre-registrants to be distributed at our meeting. Please register as soon as you can so we can plan the refreshments, dinner, luncheon, and transportation for you. Please also note that the Penn Stater will hold rooms for us at the conference rate until February 23rd. Please mail this form along with your check made out to MTSMA to:  Dan Zimmerman, MTSMA Treasurer5597 Seminary Rd.
 Apt. 2411
 Falls Church, VA 22041
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