2007 Gathering Registration Form for TES members.
Please print this page, fill out and send by mail to:
TES Office Support
38 Kimball Avenue, Unit #2
Ipswich, MA 01938
Your Name ___________________________________________________________________ |
Others In Your Party ___________________________________________________________________ |
Address ___________________________________________________________________ |
City ___________________________________________________________________ |
State and Zip ___________________________________________________________________ |
E-mail address (for society communication only) ___________________________________________________________________ |
Telephone ___________________________________________________________________ |
*********** |
| Number of tickets requested_________ (Price: $135 each) |
| Payment Type: Check ____ MasterCard ____ Visa ____ |
| Card number_______________________________________ |
| 3-digit security code (on back of card) _________________ |
| Card Expiration Date:_________/__________ |
| Card Billing Zip Code:_______________________ |
| Total Amount To Be Charged:______________________ |
(The bank requires card number, expiry date, 3-digit number, and your zip code)