2001 Convention Registration Form

||New Internet Version|| 

Department Name:___________________________________

County:___________________________________________

Contact Person:_____________________________________

Contacts Phone #:___________________________________

Name

Spouse/

Guest

$3.50

Fridays

Dance

$5.00/pp

Saturdays

Banquet

$12.50/pp

Saturdays

Dance

$10.00/pp

Total

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

           
           
           
           
           

 

 

 

 

 

 

TOTAL ENCLOSED$:___________________ Be sure to include all fees!!
Make Checks Payable To
Mail To:
Convention 2001 Rumford & Mexico
Convention 2001 Registration/P.O. Box 250/Rumford ME 04276
Hosted by www.Geocities.ws

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