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Text Box: Please sign me up for the Post Polio Seminar on September 1OTH. 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 2ND in care of: 674 Hallowell Litchfield Road, West Gardiner, Maine 04345. THANK YOU, AND WE’LL SEE YOU ON SEPTEMBER 10TH AT THE CALUMET CLUB.

Text Box: PPSGM CONFERENCE SATURDAY, SEPTEMBER 10TH, 2005 THE CALUMET CLUB* 334 NORTHERN AVENUE AUGUSTA, MAINE * note new location!

REGISTRATION FORM

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

Text Box: -DIRECTIONS TO THE CALUMET CLUB- FROM THE NORTH OR SOUTH ON I-95—take the new exit 113 (Augusta-Belfast), then Route 104 toward Augusta (Northern Avenue). The Calumet Club is 4/10 of a mile beyond on the right, just before the Kennebec Valley Federal Credit Union and Old Belgrade Road. 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.

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