|
| Enter your name as you want it to appear on your
badge. (* Required fields) |
| First name: |
Last name: |
|
|
*
|
| Street address: |
Additional address info: |
| *
|
|
| City: |
State or Province: |
ZIP/Postal Code: |
| *
|
*
|
*
|
| How would you like us to contact you? E-mail, phone,
mail? (Any or all) |
| E-mail |
|
| Telephone |
(nnn-nnn-nnnn) |
Postal Mail
|
|
| Enter additional names (and their relationship to
you: Spouse, son, friend, etc.) in this space, separating each with a comma. (Example:
Mary Doe, wife, John Doe, son, Jack Daniels, friend.) |
|
|
|
| The following information is requested of those
who are bringing modules: |
| Scale: Module Size (in feet):
Width: Length:
|
| Interfacing with others?: Yes
No If YES Who? |
| Will you require a Power Pack?:
Yes No An Extension Cord? Yes
No |
| Any other requirements? |
|
| Will you be attending for the weekend or Saturday
only? Weekend Saturday only
|
|
|
|
The following information is requested of dealers
and others who may have items for sale —
NOTE: After April 16th, 2012, table fees
double to $40.
|
| Will you provide a door prize, in the form of merchandise
or a gift certificate? Yes
No |
|
|
|
(Tables are $20.00. Table size is: 8' x 2½'.)
|
| Dealer Name (If used) |
| Special requests (Away from wall, hall location,
electric, etc.): |
|
|
|
|
|
| Please make check or money order payable to:
Bruce Saylor. |
|
| How did you learn of the Mid-Atlantic Narrow Gauge
Guild and our annual Module Meet? |
|
|
|
| Thank You! |
|
|
Click Send, then print out the form if you would like a copy,
and mail a check or money order to: Bruce Saylor, 2836 Leon Ave., Audubon, PA 19403.
If you wish to receive acknowledgement of your registration by mail, please include
a SASE. Those registering on-line will be e-mailed if a valid e-mail address is included.
Should you have any question regarding this form or the Module Meet in general, contact
Bruce Saylor at
bgsberk@comcast.net.
For a printable form, check here (PDF
version.) |
