RESERVATION FOR NEHCA FALL BANQUET

Saturday October 15, 2005

Name(s)_____________________________________________________

Number Attending Banquet: Adults ________ @ $25 each

Children ______ @ $12.50 each

Total amount enclosed ______________

Please send check payable to NEHCA by September 30, 2005 to:

NEHCA, c/o Donna Jestel, 223 Moul Road, Hilton, NY 14468

________________________________________________________________________