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Text Box: Please sign me up for the Post Polio Seminar on September 11TH. Enclosed, please find a check for $__________ for _______(insert number attending) at $10.00 each. I have also included an additional contribution of $__________. Total amount enclosed $_____________. Name:________________________________________________________________ Address:______________________________________________________________

City:_______________________________________State:_________ZIP__________ Please make checks payable to: Post Polio Support Group of Maine, and mail by September 3rd in care of: 674 Hallowell Litchfield Road, West Gardiner, Maine 04345. THANK YOU, AND WE’LL SEE YOU ON SEPTEMBER 11TH AT THE AUGUSTA ELKS.

Text Box: PPSGM CONFERENCE SATURDAY, SEPTEMBER 11TH, 2004 AUGUSTA ELKS LODGE CIVIC CENTER DRIVE AUGUSTA, MAINE

REGISTRATION FORM

DETACH THE BOTTOM SECTION AND MAIL WITH YOUR CHECK BY SEPTEMBER 3^RD

Text Box: -DIRECTIONS TO THE AUGUSTA ELKS CLUB- FROM THE NORTH—Take I-95 South to exit 112-B (formerly exit 31B), 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 I-95. Look for the big elk on the lawn in front of the club. FROM THE SOUTH—Take I-95 North to exit 112-B (formerly 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 I-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 sponsor, the Pine Tree Society, and for the funds generated by the silent auction and 50/50 drawing.