Registration Form:

Name:
Title:
Affiliation:
Address:
City: State: Zip: Phone: Fax:
E-mail:
Fee: $75 $30 - Student/Municipal Employee
Payment: Check to be mailed (Payable to Spirit of Springfield)
Credit Card (MasterCard, Visa, Discover, American Express)
Name on Card:
Credit Card #:
Expiration Date:
Total Charge to Card:

FAX TO: (413) 739-0276
For Additional Information Contact
Spirit of Springfield
101 State Street
Springfield, MA 01103
(413) 733-3800