Register Now To Attend the May 6 Gala Event
Order your seats using this form.
Print it out and mail in with payment, or call 1-800-442-2092.
1) Your name(First,Last):
2) Organization/Affiliation:
3) Street address:
4) City:
5) State and zip:
6) E-mail address:
7) Daytime Phone #:
8) I want to:
Attend
Request Scholarship Assistance
Make a Contribution to support WWC's work
9) Number of seats at $35.00:
10) Amount Enclosed/To Charge:
11) Credit card:
Master Card
VISA
12) Card number:
13) Name on card:
14) Expiration Date:
01
02
03
04
05
06
07
08
09
10
11
12
/
2004
2005
2006
2007
2008
2009
2010
Mail registration form to:
Maine Centers for Women, Work & Community
46 University Drive
Augusta, Maine 04430
Close this Page to Return to WWC Website
