REGISTRATION FORM

Back Roads Outing to Nantucket:
Tuesday, September 22, 2009

Name: ___________________________________________
Address: _________________________________________
City:______________________ State: ___ Zip: _________
Phone: _______________________
Email address: _________________

Number of reservations ____ at $90.00 each.

Total amount: __________

Checks to be made out to “Backroads of the South Shore”. Send to:

Paula Fisher, "Backroads Trip"
c/o Plymouth County Development Council Convention & Visitors Bureau
170 Water Street, Suite 24
Plymouth, MA 02360

Please print out this form and send to above address.