Please fill out the data below and then submit the form to register for this months Professional Development Meeting or call Tim Mackin @ 860-678-6578

First Name:

Last Name:

Email Address:

Company Name:

Membership Status:
Member:
Non Member:
Student:
Retired:
Unemployed:

Pricing:
$25 Members/Non-Members
$10 Retired/Unemployed
No Charge - Student Chapter Members Only

Meetings begin with drinks and socializing.

Beverages include coffee and tea.

Phone Number (e.g. 800-123-4567)
(to call in the event of a cancellation):

Number attending (if more than one):

Comments / suggestions or thoughts about our meetings are welcome too:

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If it is complete the click the submit button: or clear