List your full name as you would like it on your name badge

 	     First Name: 
              Last Name: 

 	        Company: 

	          Phone: 

  	         E-mail: 
  

           Work status:  Normal    Student   Unemployed   Retired
                      
    (Students,  retirees, and unemployed qualify for a 50% discount on the dinner cost.
       Note:  Professor must arrange reservation for student to qualify) 
 
	       Member status: Chicago Section Member   Guest of Member  Non-member
        (The posted registration fee includes a $2 discount each for Section members
         and one guest.  The cost will be $2 more for non-members.)
	Of what local section are you a member?   

Is this the first Chicago Section local meeting you've ever attended?   no   yes
Meeting Information:
  
        Day of meeting:             
        Please register at a later date for any future meeting  
  
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Dinner Selection:   Chicken Florentine    Salmon     Vegetables Wellington

• Chicken Florentine with Mozzarella cheese, Sun Dried Tomatoes, and Beurre Blanc Sauce, or
• Jack Daniel’s Glazed Wild Salmon with Stone Mustard Glaze, or
• Roasted Vegetables Wellington

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