P.O. BOX 660, Deer Park, NY
516-922-7855 phone www.lialarm.org
Annual "Auction/Election" Meeting
Please let us know if you can donate any item(s) to be raffled off
They can be mailed to the above address or call the above # for arrangements to be picked up.
Cost: $225.00 Member price (may be applied to a membership package if paid prior to
package selection, refer to Associate Membership Application)
$275.00 non member price
ATTENDEE Name: _______________________________
Contact telephone #: _______________________________
Payment Type: ____check ____Credit card (Please check one)
____ Mastercard ____Visa ____American Express
Card #: ______________________________________ Zip code____________ (affiliated with card)
Exp ____ ____ / ____ ____ Code: ____ ____ ____ ____
Do you require Electric at your table?