LOOM GMA PRE-REGISTRATION
GEORGIA MOOSE ASSOCIATION
STATE
CONVENTION
PRE- REGISTRATION FORM
SEPTEMBER
23-26, 2010
NAME_______________________ LODGE NAME AND #__________________
MID #________________
EXPIRITION DATE__________________
PILGRIM_______
ADMINISTRATOR_______
FELLOW________
GOVERNOR __________
M/ LEGIONAIRE____
PAST GOVERNOR ___________
ADVANCE REGISTRATION FEE
$10.00
(IF DESIRED) FELLOWSHIP BREAKFAST
$11.00
(IF DESIRED) PILGRIM LUNCH
$15.00
TOTALS PAID CK#
________
$__________
REMIT CHECK OR MONEY ORDER TO: Georgia Moose Association Inc.
62 Honey Lane
Mc Donough Ga 30252
Pre-registration accepted until September 10th
2010 after which fee is $15.00
Hotel reservations can be made by calling 1-912/ 786-7777
REGISTRATION ACCEPTED NOW