Text Box: REGISTRATION FORM ( PLEASE PRINT)   FAMILY’S LAST NAME: ____________________________________________________ EMAIL _________________________________________________________________ ADDRESS ______________________________________________________________ CITY ______________________STATE/PROV _________ZIP/POSTAL CODE__________ TELEPHONE _____________________________________________________________ # OF PEOPLE ATTENDING ______  WILL YOU BE STAYING AT THE  GRAND LODGE? ____  ADULT (12+) NAME (S) (first & last ) and AGE :  1.__________________________________________ 2.__________________________________________   3.___________________________________________ 4. __________________________________________  CHILDREN ATTENDING (0—11) NAME (S) (first & last ) and AGE                                            Name                                                             age                                                       1. _______________________________Daycare ____ 2. _______________________________Daycare ____ 3.    _________________ ____________ Daycare ____ 4.  _______ _______________________ Daycare ____ In an effort to provide childcare it is vital that we know how many children will require childcare. Only children registered in advance will be admitted to childcare. Children in care will not be permitted to leave the childcare facility unless accompanied by a childcare provider or the responsible parent/guardian. If a child has special medical needs (e.g. feeding tubes, oxygen) they will be admitted to childcare but only with a designated babysitter that you provide. Any child who is determined to be destructive or disruptive will not be allowed to stay in childcare. If a child is sick they should not be left in childcare.  I WILL NEED #_____ HIGHCHAIR (S) I WILL NEED # _____ BOOSTER (S) SEATS For your convenience we accept: PAY PAL: Checks and Visa OR Master Card _____   PLEASE PRINT NAME AS IT APPEARS ON CREDIT CARD   NAME: ____________________________________________________________________________________________________     __  __  __  __ - __  __  __  __ -__  __  __  __ - __  __  __  __             __   /  ____       _______ ACCOUNT NUMBER                                                4 DIGIT EXPIRATION 3 digits (back of card)   _________________________________________ AUTHORIZED CARDHOLDER SIGNATURE BILLING ADDRESS (if other than  person registered for the meeting):   _________________________________________________________________________________________________________    CITY: ____________________, STATE/PROV: _______ ZIP/POSTAL CODE:_______________ COUNTRY:____________________   AREA CODE : ____TELEPHONE :___________________  EMAIL: ________________________________________________      

Text Box: SEND COMPLETED FORM TO: TNSSG, Inc. , P O BOX 145, UPPERCO, MD 21155     Questions? Call Us Direct at: 410-374-5245

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