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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 $125.00 per individual or $250.00 per municipality/district to: Mark D. Abrahams, President For more information contact Mark D. Abrahams
at 617 803-8529 or at Bettergov@aol.com |