*Name:
*Company:
*Company Address:
*City:
*Zip:
*Phone:
*Email:
*The following individuals will attend with me ($15 per attendee):
Do you personally know state legislators?
If YES, then what legislator(s) do you know?
Are there any specific legislators you would prefer to meet with?
If YES, then who would you like to meet?
Enter total amount to be charged to your credit card:
Card Type:
Name on the Card:
Card Number:
Expiration Date:
When paying by check:Please make payable and mail to the Michigan Restaurant Association, 225 W. Washtenaw, Lansing, MI 48933; include this registration form.
