Registration Form for PA NOW Convention and PAC

Luncheon
October 1, 2011 Crowne PlazaBucks County 4700 Street Rd
Trevose, PA 19053

Mail your checks/credit card information to: PA NOW, P.O. Box 8614,
Wilkinsburg, PA 15221. If paying by credit card, you can also fill out
this form and email to our Treasurer at pmacfish@aol.com.
Make convention registration check out to PA NOW, Inc. & a separate
PAC Luncheon check to PA NOW PAC.
#___ NOW member @ $50.00 each = $____
#___Sliding scale NOW member (starting @ $0) = $____
#___ Non-member registration (@ $70.00 each, includes membership) =
$____
Total Amount paid to PA NOW, Inc. (add amts. from above) $_____
#___ PAC Luncheon (@ $50.00 or more/person, via separate ck. made
out to PA NOW PAC) *deadline to register for luncheon is Friday,
September 23 = $_____
Name_________________________________________________
Address_______________________________________________
Credit Card #_________________________Exp. Date__________
Signature______________________________________________
Names of Additional Registrants____________________________