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Registration Form for
Annual Conference 2009



GENERAL INFORMATION
    First Name  
    Last Name  
    Address  
    City  
    State  
    Zip  
    Phone  
    Email  
    Arrival Date  
    Departure Date  


PERSONS ATTENDING
(Please include age & gender for children)
    NAME AGE          
    		MALE  
    		FEMALE
Please email additional names with ages & gender to


MEALS YOU PLAN TO EAT ON THE GROUNDS:
Meal Menus (opens in new window)
      Thursday Friday Saturday Sunday
    Lunch Supper Lunch Supper Lunch Supper Lunch
    # Adults
    # Children


I (WE) REQUEST LODGING IN A PRIVATE HOME:
    # of couples:   # of singles:   # of children:

    Nights:   Wed   Thu   Fri   Sat

    Special Needs:


ARRANGEMENTS FOR LODGING WILL BE MADE BY ME AS FOLLOWS:
    Staying in the home of
    Name of hotel or B&B
    Name of campground
    My arrangements are not
    yet confirmed and/or disclosed.


TRANSPORTATION TO/FROM AIRPORT REQUESTED
    Airport  
    Airline  
    Flight #  
    Arrival  
    Departure  


I am age 12 or younger.
I am age 13 or over.




For more information:
Elmer & Ileen Miller: 319-656-3843 or 319-936-7657




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