Registration
Form
Student Activities Account 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 |