|
Full Name: ________________________________________________
Street Address: ________________________________________________
City / Town: ____________________________
State:______________ Zip: ____________________
DOB:
_____________________ Email Address: ____________________________________
Phone#: ___________________(h)
/_______________________(w)
/_______________________(c)
Attending private VIP Reception (Friday
evening): Y/N
Full Name: ________________________________________________
Street Address: ________________________________________________
City / Town: ____________________________
State:______________ Zip: ____________________
DOB:
_____________________ Email Address: ____________________________________
Phone#: ___________________(h)
/_______________________(w)
/_______________________(c)
Attending private VIP Reception (Friday
evening): Y/N
Full Name: ________________________________________________
Street Address: ________________________________________________
City / Town: ____________________________
State:______________ Zip: ____________________
DOB:
_____________________ Email Address: ____________________________________
Phone#: ___________________(h)
/_______________________(w)
/_______________________(c)
Attending private VIP Reception (Friday
evening): Y/N
********************************************************************************************
| |
No. Attending |
Total Cost |
|
Total number of Symposium attendees @149 per: |
____________ |
____________ |
|
Total number of
VIP Reception guests @ $119 per: |
____________ |
____________ |
| Addition patriotic contribution toward the
national symposium series: |
____________ |
____________ |
|
Total Amount Due: |
|
$ ___________ |
Method of Payment:
c Check
c
PayPal
Please print this reservation form and forward it with
your personal check or
PayPal receipt
to:
America’s Truth Forum,
P.O. Box 802,
Glastonbury, CT. 06033
Attendance is limited.
This reservation form constitutes a
contract between the attendee and America’s Truth Forum. Said contract is
subject to the
terms and conditions specified on
reservation form addendum.
(ATFFORM#0429) |