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:

For Additional Information or to place a reservation in person Contact