MTSMA REGISTRATION FORM 2010
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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.)
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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 _______
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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** |
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How many? ______ Total: $ ______ |
$15 (for retired people, students, and those not presently employed) |
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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 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 Treasurer
5597 Seminary Rd.
Apt. 2411
Falls Church, VA 22041
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