2007 Technology Awards Gala
Geeks In Black

Gala Home Sponsorship Opportunities Criteria Award Categories & Nomination Forms 2007 Photos

The 2007 Award Finalists

Sponsors

Megabyte

Kilobyte

Special Effects & Production

Registration Form

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) 857-3003 or joe@mesda.com.

Download a printable Fax or Mail form here

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):

Payment Information:

Event Registration Fees: MESDA Members* $59.00; Non-Members $79.00;

*MESDA Members may bring guests at the member rate.

# of MESDA Members Attending: x $59

# of Non-Members Attending: x $79

Total amount enclosed $

Select payment method:

Account Number:

Name on Account:

Billing Address:

Expiration Date:

Card Verification number*:

Please call me at this telephone number for my credit card information:

*This is the 3 digit non-embossed number printed on the signature panel on the back of the card immediately following the Visa or MC card account number or the 4 digit, non-embossed number printed above your account number on the face of your American Express card.

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, 506 Main Street, Ste 24, Westbrook, ME 04092.

Download a printable Fax or Mail form here

2007 Technology Awards GalaGeeks In Black

2007 Technology Awards Gala
Geeks In Black