Personal Information

Name

Club

District

Classification

Preferred Badge Name

Address

City

State

Zip

Tel.

Fax

E-mail

Spouse Name

Registration Fee: $ US (per person)

Registration fee includes Dinners, Snack Breaks, Lunch and Home Hospitalities.

Before September 20, 2007 = $80 per person

September 20 - Oct. 24, 2007 = $95 per person

AT THE DOOR = $115 per person

______________________________________________

Indicate Attendance #

$.00 USD x

TOTAL