| State Chapter |
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| Contact Name: |
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| Phone: |
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| Fax: |
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| E-mail: |
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| Check here if your chapter will not be hosting a reception/meeting this year. Do not complete the remainder of this form.
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Anticipated Attendance:
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Desired Room Set-up:
Conference Table
Banquet Rounds
Reception
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Will you be conducting a Business Meeting?
Yes
No
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Chapter(s) we are willing to share meeting space with:
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