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Northern California Sub Regional Meeting Registration Form

The Northern California Sub Region will be holding a meeting & Educational Seminar Saturday, June 19, 2010, 11:00 a.m. - 2:00 p.m. at Keefe, Kaplan Maritime, Inc., 530 Cutting Blvd., Point Richmond, California 94804. (510) 235-5565. - 3 CE / Education Credits

REGISTRATION FORM
You can fill out this form on your screen, then print it.

Name: - AMS#: or SA:
Spouse-Guest:
Company:
Address:
City: , State/Province: , Zip:
Phones:
Cost of meeting $25.00 US per person.

Make checks payable to SAMS® - Fee collected at the door.
For info contact: Kevin Moore, SA, Pacific Sub-Regional Director
Sausalito, CA, Tel: (707) 546-3519, Cell: (707) 217-6040
- Email: KDMA@aol.com

Please fill out this registration form for recording of your CE credits and bring with your fee to the meeting.
(Credit Card payments may be called in directly to the International Office in Florida USA at 800-344-9077, or faxed to 904-388-3958.)

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