Registration Form

ACA/NNE Chapter Meeting and Seminar
Thursday, October 7, 2021
SG Torrice, Westbrook, ME | 9:00 am - 12:00 pm


Company		Address *
City	*	State * Zip * Phone *

Name # 1	*	Email # 1
Name # 2		Email # 2
Name # 3		Email # 3
Name # 4		Email # 4
Name #5		Email # 5
Name # 6		Email #6

Fees
Members = $25.00 per person; Non Members = $50.00 per person
Event Sponsor = $1,000.00 (Includes four registrations)
Tabletop Sponsor = $200.00 (Includes one registrations)
Non-members can deduct the meeting fee paid from the membership dues by joining ACA/NNE within 24 hours of the meeting.

Payment
Members:		Member Total
Non Members:		Non-Member Total
Sponsor: Event Sponsor Tabletop Sponsor

Total:		Credit Card Master Card VISA AMEX
Account #		Security # Mo Exp. Yr. Exp.
First Name		Last Name Email





ACA/NE \| 11 Robert Toner Blvd., # 234, North Attleboro, MA 02763 \|508-839-3407 \| www.acane.org \| katie@acane.org