2019 State Convention Registration Form

WyCB 2019 State Convention
 
NAME(s)_____________________________________________      
 
ADDRESS____________________________________________
 
CITY________________________STATE/ZIP______________
 
PHONE______________________________________________
 
PREFERRED PROGRAM FORMAT:
LARGE PRINT ______        BRAILLE ______        STANDARD _______
 
Please indicate if you will be needing transportation in Casper.  ____
 
MEAL: select EITHER sandwich or salad and preference.
 
SANDWICH SELECTION - ENTER DESIRED # ____
ROAST BEEF _______       CLUB  (Ham, Turkey, Bacon) ______
 
SALAD SELECTION - ENTER DESIRED # ____
SALAD _____         Roast Beef _____        Club _____       No meat _____
 
ART ACTIVITY(select one):  CROSS ____       HEART ____      STAR ____
 
The convention registration fee of $25 per person covers refreshments, lunch and all convention materials.
 
Fee for registration received after June 10 and prior to June 19 will be $40.
 
Please mark your selections above.  Mail completed form along with your check made payable to “WyCB” to.
 
Ilene Whiteley, Treasurer
PO Box 433
Evansville, WY 82636