Brunch Form
Please complete this form clearly and print. One person per form.
First name: M.I: Last name:
Address: Apt:
City: State: 9-digit Zip Code:
Email:
VP#: FAX:
Please pick only one of 2 "dot" selections. I will be able to attend the brunch at Clarion Hotel (Sunday morning) $20.00 I will not be able to attend the brunch on Sunday morning (Please email to let Tom Garro know I am not able to attend to.) * The cost of brunch is $20.00 (including gratitude, tax and fee for the private room). The deadline of filling the brunch form will be on September 15, 2010 Please mail this brunch form with a personal check, cashier’s check or money order, payable to ‘Tom Garro’ Tom Garro 226 Loper St.Southington, CT 06489-1870 No Personal check accepted after September 1, 2010.
Click the "BACK" button to return the previous page