C o n f e r e n c e   R e g i s t r a t i o n   F o r m

Number attending: ____________________________________________________________ 

Names (please print): ________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

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Address: _____________________________________________________________________

City: ________________________________________________________________________

State: _____________________ Zip code: _______________________________________

Home Phone: __________________________________________________________________

Work Phone: __________________________________________________________________

E-mail address: ______________________________________________________________
(For conference use only)

Number and ages of children requiring child care: ____________________________

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Please mail with your check or money order to:

	New England AHA Conference,
	51 Pleasant Street, PMB 105
	Malden, MA 02148-4904
Make checks payable to “Humanist Association of Massachusetts”

A registration packet containing directions and information about local
accommodations and amenities will be sent on receipt of  your registration.