2003 ROYAL Awards Dinner Reservation Form

Directions:
The Center Club is located on the 16th floor of the Legg Mason Tower in Baltimore (Light & Pratt Sts.) Enter parking lot from Light or Charles St.

Print this form out and choose one of the following options:
Fax completed form, including credit card information or check/money order to (410) 752-8295 OR
Mail form to: MICA, 720 Light St., Baltimore, MD 21230

NAME:______________________________________________________________________

Company:____________________________________________________________________

Address:____________________________________________________________________

City/State/Zip:____________________________________________________________________

Phone Number:________________

Please check the method of payment:
MICA Member - $75 Non-member - $95

Check/money order enclosed — made payable to MICA.

Please Charge My Credit Card: MasterCard VISA American Express

Acct:____________________________________

Signature:_____________________________________

Expiration Date:_____________