NAME_________________________________________________

LAST FIRST

CITY/TOWN

REPRESENTED___________________________________________COUNTY_____________________

PLAN CHOICE (S) _____________________________________________________________________

ADDRESS_________________________________ PHONE ____________

CITY/TOWN_______________________________ ZIP ________________

COMMUTER – WHICH DAY(S) __________________________________________________

Banquet (check choice)

· Filet Mignon with Bordelaise Sauce __________

· Pistachio crusted Chilean Sea Bass __________

· Stuffed Chicken breast with Brie and Apples __________

· Gnocchi Primavera __________

AMOUNT DUE_______________ AMOUNT ENCLOSED________________

ROOM RESERVATIONS - PLEASE FILL OUT FORM BELOW
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

ARRIVAL DATE_______________DEPARTURE DATE________________

Name of co-occupant if other than “Plan A”____________________________

______ List special Dietary Needs: ___________________________________

ALL ROOMS ARE NON-SMOKING. THERE ARE NO “SMOKING ROOMS”.

MAKE CHECKS PAYABLE TO: “Connecticut Tax Collectors’ Association, Inc.”

PLEASE RETURN TO: DEBRA A. GUERRETTE

REVENUE COLLECTOR

ONE CENTRAL SQ

PLAINVILLE, CT 06062

NO REFUNDS OR CHANGES CAN BE MADE AFTER MARCH 13, 2009

QUESTIONS????? CALL-DEBBIE AT 860-793-0221 EXT. 237