Please print out a copy of this page, complete and send this form along with a check payable to "Treasurer, NHRHTA, Inc." to:
Bill Nickerson
9 Southwood Road
Enfield, CT 06082
Having trouble printing this page? Try clicking anywhere on this form with your left mouse button first before printing to make this the active frame.
| Quantity | Total Price | ||
| NHRHTA 2003 Calendar @ $9.95 each | |||
| 6% Connecticut Sales Tax ($0.60 per Calendar): | |||
| 5% Massachusetts Sales Tax ($0.50 per Calendar): | |||
| Shipping (per calendar -- contact Bill Nickerson if ordering more than 3): | ______ calendars X $2.05 each | ||
| Amount Enclosed: | |||
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 Bill Nickerson.
Please make your check payable to "Treasurer, NHRHTA, Inc." Connecticut and Massachusetts residents must include sales tax. Mail your check and this completed order form to:
Bill Nickerson
9 Southwood Road
Enfield, CT 06082
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.