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LOOM GMA PRE-REGISTRATION 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 PRINT THE ABOVE FORM, FILL-OUT, AND MAIL ALONG WITH YOUR CHECK OR MONEY ORDER. |