Optional Excursion to "The Cottage" - Registration Form:

Open the Registration Form as a PDF Document

Name:        __________________________________________________________________

Address:    __________________________________________________________________

City:            ___________________________ State, Zip:   _____________________________

Phone:       _____________________        Email: ____________________________________


Registration Fees for Excursion to "The Cottage" - $25 per person
 

$_______


Total
(made payable to ITMS):  
 

 $_______

Please print and return this form, with check or money order made out to ITMS, to:
Julianne E. Wallace
P. O. Box 845
Reading, PA 19607