The Post Polio Support Group of Maine
 c/o 674 Hallowell-Litchfield Road West Gardiner, Maine 04345 Phone: (207) 724-3784

REGISTRATION FORM
USE THE PRINT BUTTON ON YOUR BROWSER TO PRINT THIS
REGISTRATION FORM & DIRECTIONS.
REMOVE, FILL IN FORM, AND RETURN WITH YOUR CHECK
REGISTER by SEPTEMBER 21st

DIRECTIONS TO THE AUGUSTA ELKS CLUB.

*   FROM THE NORTH—Take 1-95 South to exit 31, Route 27 North. Head North on Rt. 27 towards Belgrade. The Elks Club in on the right hand side of Rt. 27, about one mile from 1-95. Look for the big elk on the lawn in front of the club.
*   FROM THE SOUTH—
Take 1-95 North to exit 31-B, Route 27 North. Head North on Rt. 27 towards Belgrade. The Elks Club in on the right hand side of Rt. 27, about one mile from 1-95. Look for the big elk on the lawn in front of the club.
 This important seminar is open to anyone regardless of your ability to pay. We want to extend a special thanks for the extra donations from our members and generous support from the participating vendors, our sponsors Alpha One and the Pine Tree Society, and for the funds generated by the silent auction and 50/50 drawing.
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Please sign me up for the Post Polio Seminar on October 5th 2002.
Enclosed, please find a check for $__________ for ____(people attending) at $10.00 each. I have also included an additional contribution of $               . Total amount enclosed $    ______.
NOTE: The luncheon will feature baked ham. If you prefer an alternative, (chicken), how many chicken dinners you need?: ____  Be aware that the Elks Club informs us that there is a very limited number of chicken dinners available.

Name:_______________________________________
Address:_____________________________________
City: _____________State: ___________ ZIP:_______
Please mail checks by September 21st in care of Post Polio Support Group of Maine 674 Hallowell Litchfield Road, West Gardiner, Maine 04345
    www.PPSGM.org

THANK YOU, AND WE’LL SEE YOU ON OCTOBER 5th AT THE AUGUSTA ELKS CLUB.


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