Fall 2014 Meeting Registration Form Please fax registration by Nov. 25th to (508) 831-5993 or email [email protected]

Last Name______First Name______Company______

______I WILL ATTEND the ACRC/CHTE Meeting from 1:00–5:00 p.m. on Tuesday, December 2nd in the WPI Campus Center. ______I CAN NOT ATTEND the ACRC/CHTE Meeting from 1:00–5:00 p.m. on Tuesday, December 2nd. ………………………………………………………………………………………………………… ……………………………..... ______I WILL ATTEND the Reception and Dinner at Higgins House on the WPI campus Tuesday, December 2nd at 6:00 p.m. ______I CAN NOT ATTEND the Reception and Dinner at Higgins House on the WPI campus Tuesday, December 2nd at 6:00 p.m.

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______I WILL ATTEND the ACRC/CHTE Meetings from 8:00–3:30 p.m. on Wednesday, December 3rd ______I will be having breakfast on Wednesday at 8:00 a.m. ______I will be attending lunch on Wednesday at 12:30 p.m.

______I CAN NOT ATTEND the ACRC/CHTE Meetings on Wednesday, December 3rd.

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Other people from my company who plan to attend: ______Food allergies and special requests:______