February 2012 Meeting Registration Form

Use this form to register for our Thursday, February 23, 2012 Chapter Meeting, which will begin at 5:30 p.m.

Registration deadline is February 20th at noon.

Your Contact Details

First Name:
Last Name:
Email:           
Phone:         
We need your phone number in case there are problems or changes
Guest Email Addresses: (separate email addresses with a comma, please)

Notes: (e.g. special requests)

Your Membership Status

If you bring one or more guests, select only your status.

STC Phoenix Chapter Member
STC Member-at-Large
Student
Non-Member
Other Chapter Affiliation

Dinner Meal Choice

We are having a buffet featuring a variety of wraps and salads, along with chips, fresh baked cookies, and assorted beverages.

Signature Wrap (Chicken, Turkey, Veggie)
Signature Salad (Caesar/Chicken Caesar, Chef, Tom. Mozzarella)
Program Only

Payment Method

Finally, please select how you wish to pay.

Credit Card (through PayPal)
Cash or Check at Meeting

To reload and receive a new challenge for you to type in the field provided, click the circular arrows located under the "words".

 

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