Reservation information: Please enter the information for the person who will be attending as the primary contact.
                                                               NOTE: USE TAB TO FOLLOW FIELD SEQUENCE

Name
I will be attending the Dinner Meeting on   Please choose Tuesday, September 21, 2010 Tuesday, October 19th 2010 Tuesday, November 16th 2010 Tuesday, December 14th 2010 - Xmas Party Tuesday, January 18th 2011 Tuesday, February 15th 2011 - Public Speaking Tuesday, March 15th 2011 Tuesday, April 19th 2011 Tuesday, May 17th 2011 - AGM
Membership Status                                        Please choose I am a Member I am a Member: New I am a Guest: Past Member I am a Guest: Not accompanied by a Member I am a Guest: Accompanied by a Member I am a Guest: Meetup Member
The following fields must be filled out by Guests not being accompanied by a Member. Members fill out only if information needs to be updated.
Company
Occupation                Please choose Insurance Insurance-related Non-Insurance Retired Student
Street Address
Address (cont.)
City	Province
Postal Code	Country
Work Phone	Home Phone
E-mail	URL
MEAL SELECTION
Please select your meal       Please Choose Regular Meal Vegetarian Meal	Changes in meal selection should be done on or before the Friday preceding the dinner meeting.

I will be bringing the following Guest(s):

Guest 1: Name
Company
Occupation            Please choose Insurance Insurance-related Non-Insurance Retired Student	Telephone

E-mail

MEAL SELECTION FOR GUEST 1 Please select your meal       Please Choose Regular Meal Vegetarian Meal

Guest 2: Name
Company
Occupation            Please choose Insurance Insurance-related Non-Insurance Retired Student	Telephone

E-mail

MEAL SELECTION FOR GUEST 2 Please select your meal       Please Choose Regular Meal Vegetarian Meal

Guest 3: Name
Company
Occupation            Please choose Insurance Insurance-related Non-Insurance Retired Student	Telephone

E-mail

MEAL SELECTION FOR GUEST 3 Please select your meal       Please Choose Regular Meal Vegetarian Meal

Guest 4: Name
Company
Occupation            Please choose Insurance Insurance-related Non-Insurance Retired Student	Telephone

E-mail

MEAL SELECTION FOR GUEST 4 Please select your meal       Please Choose Regular Meal Vegetarian Meal

Guest 5: Name
Company
Occupation            Please choose Insurance Insurance-related Non-Insurance Retired Student	Telephone

E-mail

MEAL SELECTION FOR GUEST 5 Please select your meal       Please Choose Regular Meal Vegetarian Meal

Payment: (option to pay with credit card via PayPal)

Please select method of payment

Please Choose Credit Card via PayPal Cheque

Name on credit card (to match this order to PayPal payment)

Total Attendees on this Reservation

Please Choose I Member 1 Member + 1 Guest 1 Member + 2 Guests 1 Member + 3 Guests 1 Member + 4 Guests 1 Member + 5 Guests I Guest 2 Guests 3 Guests 4 Guests 5 Guests 6 Guests

Please select method of delivering payment

Please choose PayPal Pay by cheque at the door

NOTES: 1) Deadline for Reservations, Cancellations, and Meal Changes is at noon on the Friday preceding the dinner meeting. 2) If you make a Reservation for a Guest... You are responsible for paying for your Guest's meal even if he/she does not show up. 3) Please bring payment at the door if not paying online. 4) Please do not drink and drive. 5) By submitting this completed order form you are stating that you are in agreement with these terms.