Name

Organization

Address

City, State, Zip

Daytime Phone Number

E-Mail Address (required)

I will be coming to the         select month... January February March April May June July August September October November December meeting:
     Note: If you do not cancel by the reservation deadline, you will be billed.

Additional names and email addresses of people coming:

Costs:

$15 for each member     $22 for each non-member

Total amount you will pay:

$ Make checks payable to the AFP North Central Ohio Chapter

Payment option:

I will mail a check.
I will charge my credit card.
I will pay at the door.

Questions for the speaker(s):

Who else should receive this newsletter?