Name: _____________________________________________________________

Company:__________________________________________________________

Guest (s): _________________________________________________________       

__________________________________________________________________   
 
__________________________________________________________________

(use additional sheet if necessary)

___ $55/person before 6/04/08 ($65/person after that)

___ $525/Corporate Table of Ten before 6/04/08 ($600 after that)

___ Check Enclosed for $ ________________

___ Payment by Credit Card:

___ American Express    ___ Visa/Mastercard


OR register on-line at www.hsmai-az.org

Card #: __________________________________________

Exp. Date: _____________ 

Signature: _______________________________________

Request ______ Vegetarian Plates