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.