2004 Large-Scale Service Project
St. Louis, Missouri
Registration Form

Name 	 	 	 	
School Mailing Address		Summer Mailing Address	

Email 	 	 	 	
School Phone Number	 	Summer Phone Number	 	
				
Classification	 	Age	 	
Club	 	District	 	
Office Held, if any	 	 	 	

Please list any restrictions, dietary or otherwise:

•	Do you want a t-shirt?  Yes   No
	If yes, what size?  M  L  XL  other: _____ 
	Please include $8.00 extra with your registration to cover the cost of the t-shirt.
•	How will you be arriving in St. Louis? 

•	If you will be arriving late, please indicate when you expect to arrive.

Other comments:

Please return this form along with $115.00 for registration (plus $8.00 if you want a t-shirt) to
Cathy Collier
P.O. Box 863403
Tuscaloosa, AL 35486
by 5/15/2004.  Any registrations received after this date cannot be guaranteed and will be required to be accompanied by a $15.00 late fee.  Checks should be made out to Circle K International.

If you have any questions, please call or email LSSP Chair Cathy Collier at (256) 390-2553 or cathiness@fastmail.fm.

Thank you!