San Andreas Chapter - August 30, 2010 Registration Form

This is the registration for the San Andreas Chapter Program Meeting on August 30, 2010 from 6:00-8:30 pm at Michaels at Shoreline, Mountain View.

Silicon Valley - A History of Change / Vote on Chapter Name Change

Speaker: Leslie Berlin

We would appreciate registration/payment by Monday, August 23, 2010 in order to give an accurate count for catering.

Please consider making your payment through PayPal.

If paying by check, the registration fee is payable to San Andreas Chapter of SLA.

Mail your check to arrive by Thursday, August 26, 2010.

Payment options are at the end of the registration process.

Question Title

* Please enter your contact information. Each field must be completed.
If you do not want to enter certain information, please add an x to the line.
Minimum required is First/Last Name, and Email.

Note: If you are registering more than one person for this event, you will need to fill out a registration form for each person.

First name:

Last name:

Affiliation (if no affiliation use N/A):

Address:

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