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Registration Form Name _________________________________________________________________ Employer _______________________________________________________________ Position ________________________________________________________________ Business Address _________________________________________________________ _______________________________________________________________________ City, State, Zip ___ _______________________________________________________ Telephone (Work) ________________________________________________________ Fax Number _____________________________________________________________ E Mail Address __________________________________________________________ Authorized Signature ______________________________________________________ Please fax this form to 508 788-6217 or mail this form with a check or purchase order for $199.00 to: Mark D. Abrahams, President For more information contact Mark D. Abrahams at 617 803-8529
or at Bettergov@aol.com |