New Page 1

NORTH CENTRAL OHIO CHAPTER

Serving members from Summit, Stark, Cuyahoga, Portage, Wayne, Tuscarawas, Medina, Jefferson, Carroll, and Ashland Counties

Office - 330-329-2472 | Fax - 330-315-0399 |Email - info@afpncoh.org

MEETING REGISTRATION FORM
PLEASE COMPLETE A SEPARATE FORM FOR EACH PERSON ATTENDING.

Directions: Tab and type to complete this page. Print it. Click the [Submit] button to start the reservation process. PLEASE COMPLETE A SEPARATE FORM FOR EACH PERSON ATTENDING.

If you make a reservation, you are responsible for the fee even if you do not attend. Cancellations must be received by the posted reservation deadline; if you do not cancel by that time, you will be billed or forfeit a refund for any payment.

Questions? Phone: 330-329-2472

Live Help: www.jacqconnect.us/go

Name
Organization
Address
City, State, Zip
Phone	000-000-0000
Email (required)
I will be attending the meeting
Costs	$15 for each member $22 for each non-member For June only: guests of members pay the $15 member price!!
Are you a member of AFP? Yes No If you are a non-member attending as a guest of a member, please enter that person's name: Would you like information about joining AFP? Yes No
Total amount you will pay	$
Payment option	I will mail a check. I will charge my credit card. I will pay at the door.	Note: If you do not cancel by the reservation deadline, you will still be billed for the meeting.
Questions for the speakers:
	Please enter this number in the gold field. If you do not, you will receive an error message. If you receive an error message and you have entered the number, please call 330-329-2472 so that we can fix the problem.