Registration Form *Check* Primary Attendee’s Full Name (as you want it on your name tag) *Additional AttendeesPlease complete entries for each attendee – include spouses as an additional attendeeAdditional attendees’ full names from the same museum or organization (include spouses) Please list each attendee on a separate entry lineAdditional attendees’ full names from the same museum or organization Please list each attendee on a separate entry lineAdditional attendees’ full names from the same museum or organization Please list each attendee on a separate entry lineAdditional attendees’ full names from the same museum or organization Please list each attendee on a separate entry lineRegistrant Address Address Line 1CityState / Province / RegionZip / Postal CodeName of affiliated museum or organization Member# Additional attendees’ full names from the same museum or organization Please list each attendee on a separate entry lineAdditional attendees’ full names from the same museum or organization Please list each attendee on a separate entry lineAdditional attendees’ full names from the same museum or organization Please list each attendee on a separate entry lineAdditional attendees’ full names from the same museum or organization Please list each attendee on a separate entry lineEmail *Telephone Number Mobile number for contact during the seminar Multiple Choice Registration Members – $ 150.00Registration Non-Members – $ 180.00Quantity Total 360.00 To Pay by Check: 1. Complete this form online. 2. Press Ctrl + P (Windows) or Cmd + P (Mac) to print this page for your records. 3. Mail your check payable to The Mansfield Fire Museum to: 1265 W 4th St, Mansfield, OH 44906 4. Click the Submit button below to finalize your registration in our system. MessageSubmit