1998 Dum-Dum REGISTRATION
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REGISTRATION:
Name(s) ______________________________________ Address _____________________________________ City/State/ZIP ________________________________ Telephone _________________ E-mail _______________________________________ Arrival Day/Time ______________________________ Registration Fee of $75.00 per person is enclosed:......................... $______ Additional banquet ticket(s) at $20.00 is(are) enclosed................... $______ ADDITIONAL INFORMATION: I am a paid-up Burroughs Bibliophiles (BB) member ____yes ____no My ERB-List persona is _____________________________________________ I would like to reserve a Huckster Room table ________
I have artwork to display (not for sale) _____
I have artwork for sale ____________
I have an item(s) for the BB Benefit Auction _____
I have an item(s) for the Panthans Benefit Auction _____
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payable to John Tyner, Treasurer, and MAIL the form to:
National Capital Panthans If you should have any questions, e-mail jt110p@nih.gov or call John Tyner at (301) 468-2146. |
HOME | TALIESAN ASSOCIATES | ROCKVILLE CHAMBER OF COMMERCE | BRIGHT MOON PRODUCTIONS | TYNER'S TIGERS | CAPITAL DISTRICT KIWANIS | NATIONAL CAPITAL PANTHANS | Copyright © 1998 by Taliesan Associates. All Rights Reserved. |