2009 ANNUAL MEMBER MEETING November 4-6, 2009 The Atherton Hotel 125 South Atherton Street State College, PA 16801 Tel: 800-832-0132 or 814-231-2100 Fax: 814-237-1130

Registration Form

Registration Fee:          Member*        $250.00                  Non-Member                $300.00

                    Spouse/Guest         $150.00                        Spouse/Guest                $150.00

Registration Fee:          State Officials                $125.00

*Additional members will pay $250.00 each and $150.00 for a spouse/guest

COMPANY NAME OF MEMBER(S):_____________________________________________

Enclosed is payment in the amount of $___________, representing for the following individuals:

Attendee:_____________________________________________________________________

Spouse/Guest:_________________________________________________________________

Attendee:_____________________________________________________________________

Spouse/Guest:_________________________________________________________________

Attendee:_____________________________________________________________________

Spouse/Guest:_________________________________________________________________

Attendee:_____________________________________________________________________

Spouse/Guest:_________________________________________________________________

TOTAL NUMBER OF PEOPLE ATTENDING (Attendees & Spouse/Guest)_______________

Return REGISTRATION FORM & REGISTRATION FEE on or before October 3, 2009: