The
NCA Birthday Bash Registration Form
Register online at www.costumers.org, or complete and mail this form.
Name ______________________________________
Company ___________________________________
Address _____________________________________
City/State/Zip _______________________________
Email ______________________________________
Phone______________________________________
Name of Attendee #1
Name of Attendee #2
saturday meal c hoice (indicate attendee’s choice by number) c hicken Bruschetta - sauteed chicken breast, tomatoes and onions, fresh basil and balsamic glaze, seasonal fresh vegetables, red skinned mashed potatoes. s kewered shrimp - garlicky-lemon grilled shrimp skewers, creamed spinach and creamy risotto. Pasta Vegetable s campi - red lentil pasta, seasonal vegetables, light lemon garlic sauce.
Do you have any dietary restrictions, such as allergies or sensitivities? Please describe them.
Fees
___Number of attendees X $279 ($249 if registered by June 2) = _____________
__Check enclosed
__Charge my credit card: Card number
Expiration date__________ Security code_________
mail completed form and payment to:
National Costumers Association
c/o Ed Avis Associates
PO Box 13347
Chicago, IL 60613