RESERVATION FORM

CALL___________________________________________________

NAME___________________________________________________

NUMBER OF RESERVATIONS_____________________________@$18.00/person

CHECK AMOUNT_________________________________________

Please give Gary your e-mail address if you have one__________________________________

       Make checks payable to " Nutmeg Chapter #149 QCWA" and mail to Gary Awsiukiewicz, K1MQ, 261 Woodfield Crossing, Rocky Hill, CT 06067