Please furnish information about your chapter or regional chapter dinner to be included on the PWX app and provide staff information on site. If you have any questions, please contact Cameron Harmeyer at charmeyer@apwa.org or 816-595-5259.

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* 1. Name of chapter or region holding the dinner.

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* 2. Chapter contact for questions about the dinner.

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* 3. Will this person be onsite and available to answer questions

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* 4. If the answer was “no” please supply onsite person’s name, email or onsite phone number

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* 5. Please provide the Restaurant/Facility name and address

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* 6. Date of the chapter dinner

Date
Time

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* 7. List cost of the chapter dinner per person and if there is a “cut off” number of persons set for the chapter dinner please list that number here

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* 8. List menu here or any other important information

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* 9. What is the deadline to register:

Date

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* 10. Can you pay at the door

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* 11. Is there transportation provided to and from the restaurant/facility

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* 12. If listed yes transportation provided, please tell us location to be picked up and returned

T