YES! I/We plan to attend the 6th Annual Banquet of H*VMI.

Number attending:  

(Please note: We are unable to reserve seats except for the special needs noted below. If your group would like to sit together, please designate someone to arrive early to hold seats for your group members.)

We have special needs:

 Please provide wheelchair seating.
 
 Please provide a Sign Language interpreter.
 

Your Name:

 
Your Email Address: 


Your Phone Number:

 
Your Mailing Address:
  (street address)
  (city, state, zip code)
  (country)
 
Additional Comments: