NORTHEAST LINK for GSE

January 30th 2010 Event Registration

Information for Badge  
  Title   e.g. Mr, Mrs, Miss, Ms, Dr, Prof
  First Name   e.g. Robert
 
Family Name
   
e.g. Smith
 
Nickname / Call name
 
e.g. BOB (UPPER CASE)
  Gender    
       
Contact Information in USA or CANADA
 
Address  Line 1
 
e.g. 25 Main Street
  Address  Line 2    
 
City, St, Zip
 
e.g. Boston, MA 01234
 
Country
 
e.g. USA
 
Phone
 
e.g. 508-555-1212
 
e-mail
 
e.g. robert12345@hotmail.com
       
GSE Leaders & Members, Rotarians & Guest Info
  Title  for Name-Badge   Please select from list
  Rotary District #  
e.g. 7930
       
Foundation Alums    
  Alum Type   Please select from list
  Study Years   e.g. 2001-2002
  Study Institution   e.g. Edinburgh University
  Study Country   e.g. Scotland
  Field of Study   e.g. Mathematics
     
Partner Information (if attending)  
 
Partner's first name
e.g. Elizabeth
  Partner's family name e.g. Smith
 
Partner Nickname
e.g. LIZ (UPPER CASE)
  Gender  
 
Additional Information you would like NORTHEAST LINK staff to know (comments)

Registration Fee $50

The Registration Fee includes meals & seminar materials.

Payment:

A Check or Money Order in US Funds, should be made payable to NORTHEAST LINK - GSE and mailed to:

Klaus Hachfeld PDG
50 McGregory Road
Sturbridge, MA 01566
Phone: (508) 347-7903

Please indicate on the check or in an accompanying note, the names of the people whose registration is being paid by this check!

Deadline:

Please ensure that your registration is received by January 24th, 2010 

NOTE: Hotel rooms for the night of January 29th are available at the Boxborough Holiday Inn for $95. Room Reservations need to be made directly with Lindsay Dean at the hotel: (978) 889-1711 or email ldean@hiboxborough.com

NORTHEAST LINK assumes no responsibility for any medical treatment and related service expenses incurred by you and others who may accompany you during travel for, and attendance at, the NORTHEAST LINK weekend.

For additional information, contact:

PDG Karen Swaim Babin, Rotary District 7190
75 Vista Drive
Saratoga Springs, NY 12866
Tel: 518-587-7582
E-mail: ksbabin@nycap.rr.com

To subsequently change your reservation, use this form to re-register.