FAX RESERVATION SHEET

SEPA SHRM BREAKFAST MEETING 8:00 AM - 10:15 AM
PLEASE PRINT OUT THIS FORM, FILL IT OUT, AND THEN FAX IT TO US TO REGISTER. You may include a copy of this form when you mail your payment if you wish, but you MUST FAX IT in order to register in time, ONLY USE MAIL FOR PAYMENT.

Reservations must be received by the Friday before each meeting. If you are unable to meet this deadline, please try to call the hotline, (215) 698-7116, by 10AM, the Monday morning before the meeting. FAX THIS FORM TO: (215) 698-7116

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Meeting Date You Plan to Attend: ______________

# Attending: _______________________

SHRM #: _________________________

Name: ___________________________

Title: _____________________________

Email Address: ____________________

In Transition? _______If so, indicate date you joined SEPA___________

Employer: _________________________

Phone Number: _____________________

Guest's Name: _____________________

Guest's Employer: ___________________

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Make checks payable to SEPA SHRM
SEPA SHRM Administrator
c/o Human Resource Troubleshooters
9090 Pine Road - Office Suite 'B'
Philadelphia, PA 19115-4417