Registration Form
Gold Circle Awards Dinner Meeting
September 30, 2021 | 5:00 pm - 8:00 pm
Casa Mia at the Hawthorne | Berlin, CT
Company
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Address
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Phone
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City
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State
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Zip Code
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Name # 1
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Email # 1
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Name # 2
Email # 2
Name # 3
Email # 3
Name # 4
Email # 4
Name # 5
Email # 5
Name # 6
Email # 6
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
Five
Six
# of Non Members
One
Two
Three
Four
Five
Six
Sponsor
Member
Non Member
TOTAL $
Payment Type
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Master Card
VISA
American Express
First Name
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Last Name
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Email
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Account #
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Security #
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Exp. Month
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Exp. Year
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Billing Zip Code
CSA | 1131-O Tolland Turnpike, # 272 | Manchester, CT 06042-1679 Phone: (866) 995-3919
www.connecticutsubcontractors.org
|
karen@connecticutsubcontractors.org
