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GEORGIA MOOSE ASSOCIATION MID YEAR CONFERENCE PRE- REGISTRATION FORM February 25 - 28, 2010 NAME_______________________ LODGE NAME AND #__________________ MID #________________ EXPIRATION DATE__________________ PILGRIM_______ ADMINISTRATOR_______ FELLOW________ GOVERNOR __________ M/ LEGIONAIRE____ PAST GOVERNOR ___________ REGISTRATION FEE $10.00 (IF DESIRED) FELLOWSHIP LUNCH $11.00 TOTALS PAID CK# ________ $__________ REMIT CHECK OR MONEY ORDER TO: Georgia Moose Association Inc. 62 Honey Lane Mc Donough Ga 30252 Pre-registration accepted until February 10th 2010 after which fee is $15.00 Hotel reservations can be made by calling 1 478 / 746 - 1461 REGISTRATION ACCEPTED NOW PRINT THE ABOVE FORM, FILL-OUT, AND MAIL ALONG WITH YOUR CHECK OR MONEY ORDER. |