First Name:  *
Last Name:  *
Address:      *
City/State/Zip:          *
Phone:    *
Email:     (optional)

How many children requiring childcare will be accompanying you?

Children's lunches will be $2.00/child.  Lunch for adults will be available for $7.50/person.  Please select whether or not you will be joining us for lunch.   Yes No
Lunch can be paid for upon arrival.

Please select if/how you would like to be contacted for information on future meetings:   No Contact Email Phone Regular Mail  

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