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 to: Mark D. Abrahams, President For more information contact Mark D. Abrahams
at 617 803-8529 or at Bettergov@aol.com |