Annual Membership Meeting Reservation Form

Group Health's 2011 Annual Membership Meeting is Saturday, Oct. 1 at the Lynnwood Convention Center in Lynnwood, Wash.

Fill out and submit this form to reserve your seat at the meeting. Your reservation helps us plan for parking, seating, and food.

You will not receive a confirmation e-mail after you submit this form.

* Indicates a required field

* Last name:
* First name:
* Street address:
* City:
* State:
* ZIP code:
* Daytime phone:
E-mail:		Check this box to have your meeting information sent by e-mail. Send my Annual Membership Meeting Evaluation form to me via e-mail.

* Number of adults who will attend the meeting:
Number of children who will attend the meeting:
Number of children who will require child care: (Child care is free and will be provided from 9 a.m. until the end of the meeting.)

Ages of children who will be in child care:

		I am disabled and need special parking. (Group Health will not issue parking permits; you must have a state-issued permit for disabled parking privileges.)