Registration Form - Western Suffolk Counselors` Association

Western Suffolk Counselors’ Association
invites you to our annual
Spring Membership Meeting and Dinner
Thursday, May 12, 2016
4:00 pm
Stonebridge Country Club
2000 Raynors Way, Smithtown, NY 11787
(631) 656-6899 • www.stonebridgeglcc.com
Cocktail Hour (cash bar) followed by the Meeting and Dinner
As a special treat for your secretary/administrative assistant,
please extend a complimentary invitation to join you in attending the Dinner.
• Members – $10.00. One Member, One Secretary/Administrative Assistant Guest •
Non-member and Guest: $35.00 (includes WSCA membership)
On-site Registration: Members: $15.00 • Non-members: $40.00 (includes WSCA membership)
R.S.V.P. by Tuesday, May 10, 2016
Make check payable to WSCA and mail with reservation form to:
WSCA, 595 Route 25A – Suite 18, Miller Place, NY 11764
Any questions, call the WSCA office at (631) 209-0839 or email [email protected]
DIRECTIONS: FROM L.I.E. EAST OR WEST
Long Island Expressway to Exit 56 North. Travel North on Route 111 (Route 111 bears left at Jade Garden Restaurant), proceed to
Route 347, turn left. Stonebridge Country Club (Lessings Catering) is on Route 347 approximately ¾ of a mile on the right.
FROM NORTHERN STATE PARKWAY
Northern State Parkway to the end onto Vets Highway 347/454. Follow to divide. Keep left on Route 347. Make a U-turn at Brooksite
Drive. Keep to the right. Turn right at Stonebridge Country Club (Lessings Catering).
Reservation Form
WSCA Spring Membership Meeting and Dinner
Thursday, May 12 • Stonebridge Country Club
Please Print
Member and Guest: $10.00 • Non-member and Guest: $35.00
Name
Phone
Email
Make check payable to WSCA and mail with this form to:
WSCA, 595 Route 25A – Suite 18, Miller Place, NY 11764
or FAX to (631) 209-1832 with credit card information
R.S.V.P. by May 10, 2016
School/Agency
Credit Card Number
(includes membership)
Amount Enclosed $
Visa, Mastercard or Amex • Expiration Date
Address on card
Signature
No., Street, Town
Zip