HILLAH SHRINERS SPRING CEREMONIAL APRIL 21 -23 2017 ROSEBURG OR
REGISTRATION FORM Deadline for registration is APRIL 12 NAME: ______________________________ TITLE: ________________ LADIES NAME: __________________________ Make your own motel reservations. Sleep Inn & Suites 2855 NW Edenbower Blvd Reservations: 541-464-8338 (Shriner rate $93.49 + tax, king plus $5.00)
Number of people
Registration fee – $12.50 per person ___X $12.50 = ___________ Friday evening dinner $12.00 per person ___X $12.00 = ___________ Nobles lunch $10.00 per person ___X $10.00 = ___________ Banquet $20.00 per person ___X $20.00 = ___________
TOTAL ____________ ___________________________ will attend Ladies luncheon. Ladies Name Mail completed registration form and check to Hillah Shriners 3581 Leer Way Medford OR 97504 Make check payable to "Hillah Shriners”. Credit card payment - call Hillah Office during business hours. |
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