NHRHTA 2003 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:

Bill Nickerson
9 Southwood Road
Enfield, CT 06082

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NHRHTA 2003 CALENDAR ORDER FORM

QuantityTotal 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.


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