NHRHTA 2002 CALENDAR ORDER FORM

Please print out a copy of this page, complete and send this form along with a check payable to "Treasurer, NHRHTA, Inc." to:

Dennis Fennessy
138 Sand Hill Road
Middletown, CT 06457

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NHRHTA 2002 CALENDAR ORDER FORM

Note: Unlike prior years, this year we will not be shipping the calendars via bulk mail in order to ensure timely delivery. If you are ordering more than 3 calendars, please contact Dennis Fennessy.

Please make your check payable to "Treasurer, NHRHTA, Inc." Connecticut residents must include sales tax. Mail your check and this completed order form to:

Dennis Fennessy
138 Sand Hill Road
Middletown, CT 06457

Please print the following information:

Name (Last, First):_____________________________________________________

Address:________________________________________________________________

City:____________________________ State:__________ Zip:_________________

Telephone:_____________________ Membership #:__________

_____ Please check if you are an NHRHTA member and this is a new address. (6/00)

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