CSOPA FACES OF WINTER 2004 PROGRAM REGISTRATION FORM

Your Name:______________________________________

Address (For our Mailing List. Optional):_______________________________________

_______________________________________________

Email (Required to be advised of any scheduling change):

_______________________________________________

Feb 7 and 8 Programs: $100               SOLD OUT

Feb 7 Only: $60               SOLD OUT

Feb 8 Only: $60                   _______

Dinner Feb 7: $40pp (excludes cash bar)         SOLD OUT

Dinner Feb 8: $40pp (excludes cash bar)          _______

TOTAL       _______

Donation to CSOPA (a non-profit educational org.) for future events:       _______

Total amount enclosed:       _______

Kindly mail check payable to "CSOPA" to:

CSOPA

86 Campell Drive

Stamford, CT 06903

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