SEPTEMBER 2003

Event Registration Form

Event Registration Form   Greater North Suburban Chicago Chapter

EVENT REGISTRATION FORM

REGISTRATION INSTRUCTIONS

YOU MUST FIRST PRINT OUT THIS FORM l  

Complete a separate Registration Form for each workshop you plan to attend.   Be sure to include your phone number in case we have to contact you. Call the GNSC Hotline (847/562-9703) for program updates.  Enclose your e-mail address or a self-addressed stamped envelope for written confirmation of your registration.

Enclose a separate registration form and check for each event, payable to Greater North Suburban Chapter NAIC. Identify the name and date of the workshop on your check.

Mail to:

Greater North Suburban Chapter NAIC

P.O. Box 31943

Chicago, IL 60631

Name of event:_________________________________________________

Date of event:_____________________________

Number of People:_________________________(list names on the back of this form if more than one attending)

Fees enclosed: $___________________________

Name: ___________________________________________________________

Address:__________________________________________________________

City:___________________________ State:______________Zip:___________

Phone Day:(____)_______________ Phone Evening:(____)_________________

E-Mail Address: ___________________________________________________

Would you like to subscribe to "Stay In Touch" our chapter one-way announcement list?"

Yes____ No____"

Club Name (if applicable):__________________________________________

NAIC Member # (if applicable):_______________________________________o=

NAIC® Greater North Suburban Chicago Registration Form file:///C|/chapters/gnsuburban2.html [1/21/2004 10:26:52 AM]