| | | | | | |
| Chap. Exec. Committee Position: ________________________________ |
Chapter Number: _____ |
| Name: ________________________________________________________________________ |
| Company: _____________________________________________________________________ |
| Address: ______________________________________________________________________ |
| Phone: ______________________ |
Fax: __________________________ |
| E-mail (all caps please): ___________________________________________________________ |
| |
| Number attending: |
|
Conference (member) |
______ x |
125 |
= |
$ _______ |
|
Conference (nonmember) |
______ x |
150 |
= |
_______ |
|
Banquet (member) |
______ x |
30 |
= |
_______ |
|
|
Banquet (nonmember) |
______ x |
40 |
= |
_______ |
|
Annual Meeting/COC |
______ |
TOTAL |
______ |
$ _______ |
| |
| Please send check payable to SME Region 3 to: |
David Kilman |
|
520 Mohawk Ave |
|
Norwood, PA 19074 |