AAII Eastern Michigan Chapter

 Advance  Registration for Tuesday January 15, 2019

Name___________________________


Email:__________________________


Phone: (_____)___________________


Family/Guest Name(s):

 
_______________________________

Email: _________________________

Total # of Attendees: ____________

Total Fees:                $___________

Please indicate any ADA disability needs:

_______________________________

_______________________________


NO REFUNDS:
In case of cancellation, advance
registrants will attend the next
presentation free.

Presentation Speaker    /     Date


____________________________________

[ Please fill in the above line ]


Mail to:

Marilyn Brown
8505 Woodridge Dr.

Davison, Mi, 48423



*  Make Checks payable to: AAII  *


In Advance:
Everyone:
$10 / person

At the door:
$15.00 per person

Registrants/Total Fees:

Number attending _____

x $10.00 per person

Total enclosed by check  $___________

Checks must be postmarked by 7 days before the presentation date.