R E G I S T R A T I O N

- Attendee -

Registration Type*

Member Boulé*

Name*

Email*

Phone#*

Gala Dinner Entrée Selection

Entrée Choice*

Braised Boneless Beef Short Ribs & Grilled Shrimp
Stuffed Chicken Breast & Seared Salmon
Vegetarian Meal

Any special needs (wheelchair, etc.)?

Special Needs*

No
Yes

Event arrival & departure dates:

Arrival*

Departure*

Will you be attending any of these other events?

$ Paid Activities (Optional)*

Bowling Party - Friday ($30.00)
Farewell Brunch - Sunday ($20.00)
None ($0.00)

- Registration Fees -

Online Processing Fee

$0.00

Registration Subtotal

$0.00

Comp Code

Payment Due

$0.00

- Billing -

Name*

Credit Card*

Visa
Mastercard
American Express
Discover

Address*

Email*

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