Registration Form
Gold Circle Awards Dinner Meeting
March 28, 2020 | 5:00 pm - 8:00 pm
Casa Mia at the Hawthorne | Berlin, CT
Company
*
Address
*
Phone
*
City
*
State
*
- -
AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip Code
*
Name # 1
*
Email # 1
*
Name # 2
Email # 2
Name # 3
Email # 3
Name # 4
Email # 4
FEES
Member Dinner Fees = $75.00 for the first person; $65 for each additional attendee
Non-Member Dinner Fee = $110.00 per person
Member Sponsor Fee = $100.00; Non-Member Sponsor Fee - $300.00
Below, please check one box to calculate the cost for the attendee total.
Please also check the box to choose to be a sponsor.
# of Members
One
Two
Three
Four
# of Non Members
One
Two
Three
Four
Sponsor
Member
Non Member
TOTAL $
Payment Type
*
Master Card
VISA
American Express
First Name
*
Last Name
*
Email
*
Account #
*
Security #
*
Exp. Month
*
- -
01
02
03
04
05
06
07
08
09
10
11
12
Exp. Year
*
- - - -
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
Billing Zip Code
CSA | 1131-O Tolland Turnpike, # 272 | Manchester, CT 06042-1679 Phone: (866) 995-3919
www.connecticutsubcontractors.org
|
karen@connecticutsubcontractors.org
