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Please Mail in Your Registration Form and Payment to:

Tom A. Strohl

5000 Tilghman St. Ste. 147, Allentown, PA. 18104

Phone: 610-366-7774

Your Name and Your Partner’s Name___________________________________________

Your Address and Zip Code___________________________________________________

Your Phone # with Area Code_________________________________________________

To pay by Master Card/Visa (phone registration available by credit card)

Print Name As It Appears on Card _________________________________

Signature of Card Holder _______________________________________

Account # _____________________________________________

Expiration Date ______________________________

You Will Receive Confirmation of Attendance Upon Receipt of Your Registration and Payment