MTSMA REGISTRATION FORM 2012
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Name(s) 1________________________________ 2___________________________________
Institution(s) 1_____________________________ 2___________________________________
E-mail Address(es) 1_________________________ 2_________________________________
Mailing Address(es)
1____________________________________________________________________________
2____________________________________________________________________________
Banquet, Friday, March 30, 7:00 p.m. ($35 per person)
Caffé Gelato
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How many? _____ Total: $ ______ |
If you will attend the banquet, please choose one of the following:
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Homemade roasted vegetable and ricotta stuffed ravioli served with a parma rosa sauce |
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Honey-sesame glazed salmon served with mashed sweet potatoes and a cinnamon toasted almond and micro green salad |
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Pistachio encrusted chicken served oven roasted with a dill cream sauce, cous cous pilaf and sautéed vegetables |
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Tenderloin tip pasta served with a marsala wine sauce |
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Pan-roasted pork tenderloin with mushroom risotto and roasted seasonal vegetables |
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Lunch, Saturday, March 31, 12:30 p.m. ($15 per person)
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How many? _____ Total: $ ______ |
If you will attend the luncheon, please choose one of the following:
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Southern California Cobb wrap with chicken |
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Southern California Cobb wrap with hanger steak |
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Balsamic wrap with hanger steak |
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Thai wrap with chicken |
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Thai wrap with tofu |
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Registration (There are no dues. Automatic membership is by attendance or by e-mailing a request to Rachel Bergman at: rbergman@gmu.edu)
$55 if postmarked by March 21; $65 after that or at the door** |
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How many? ______ Total: $ ______ |
$15 for retired people, students, and those not presently employed if postmarked by March 21; $20 after that or at the door** |
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How many? ______ Total: $ ______ |
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Grand Total: $_______ |
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**Those who mail this registration form by March 21th 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 for you.
Please mail this form along with your check made out to MTSMA to:
Dan Zimmerman, MTSMA Treasurer
4223 35th Street South
Arlington, VA 22206
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