(You must print this form and send it with your registration fee.)

REGISTRATION FORM

STEIN COLLEGE # 13.

STEIN COLLEGE COMING SOON Spring of 2009

TO REGISTER, PLEASE SEND THIS FORM AND YOUR CHECK TO:

DAVID HARR
P.O. BOX 1107
WEST BROOKFIELD, MA 01585

Please register early as the maximum number of attendees is 40 and seating is available on a first come basis.

If staying at the hotel, please register with the hotel early, because they are only holding 25 rooms until 00/00/ 2009. After that date there may not be a room available. When you register with the hotel, don't forget to tell them your with stein college.

NAME; __________________________________________________

ADDRESS: __________________________________________________

CITY: __________________________________________________

STATE: _______________________ ZIP CODE: _________________

PHONE: ___________________________________________________

EMAIL: ___________________________________________________

PER PERSON @ 75.00 EACH  -   QUANTITY______ $___________

MAKE CHECK PAYABLE TO: DAVID HARR

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If you would rather pay for registration now, with PayPal, you may do so. Clicking HERE will take you to the PayPal site. Don't forget to indicate what the payment is for.

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