AFFIRM

President's Party Honoring Chris Niedermayer
July 26, 2008

(Please use one form per registrant; tab through the form to move
from field to field, as hitting the enter key will submit the data)

Prefix/Rank

First Name

Last Name

Title/Position

Company/Service/Org

Company Size

Email

Tel

Fax

Address Street

Address City

Address State

Address Zip

Special Needs

Guest First Name

Guest Last Name

Guest Title/Position

Guest Company/Service/Org

Guest Email

Registration Rate

	Individual -- $35
	Individual and a Guest-- $70

COMMENTS

How did you hear about
the AFFIRM Luncheon?

PAYMENT

Payment Method

All Check Payments
Should Be Mailed To:

AFFIRM
P.O. Box 2848
Alexandria, VA 22301
tel: 703-549-1160

Deadline for cancellations or refunds:
48 hours prior to the event.
No refunds thereafter.