OTR 2001 Registration Form

Type in the appropriate information, print this form out, and mail it with your check to the address shown below to complete your registration.

Name

Organization/Band

Address

City

State Zip/Postal Code

Phone (day) (night)

Email

Enclosed is a check for $90 per person (full conference registration)

Check here to receive Exhibit Hall information

Check here if you do NOT want your address to appear in the Conference Directory

Make checks payable to: Surry Arts Council

Send this form with payment to:

Surry Arts Council
P.O. Box 141
Mount Airy, NC 27030