Prepayment is required.Reservations are non-refundable. A registrant may designate
a substitute attendee by calling the MESDA office. Questions? Contact Joe Kumiszcza at
MESDA (207) 829-9195 joe@mesda.com
.
Organization:
Contact Name:
Title:
Address 1:
Address 2:
City:
State:
Zip:
Telephone:
Fax:
E-mail:
List registrants here (including
yourself, if you will be attending):
Please make meal selection notation after each name:
B - beef, C - chicken, V - vegetarian unless otherwise noted meal selection will be beef
*MESDA Members may bring a guest at the member rate.
# of MESDA Members Attending: x $75
# of Non-Members Attending: x $100
# of Tables - 8 Attendees per table - please list all registrants above: x $500
Total amount enclosed $
Select payment method:
Account Number:
Name on Account:
Billing Address:
Expiration Date:
If you prefer not to submit your credit card information over the Internet
or would like to pay by check, please send the completed registration and your payment (make
checks payable to MESDA) to: MESDA, P.O. Box 10020, Portland, ME 04104-0020.
Home
Seahorse Cinema