EmailMe Form - Pacific Northwest Conference (PNC) 2011

Pacific Northwest Conference (PNC) 2011
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Step 1: Fill out your registration information

June 24, 25 and 26, 2011
Hosted by Oregon Area 58, District 5
Bend, Oregon

Registration fee: $15.00 per person, plus selected meals

Name *

Address *

Street Address *

Address Line 2

City *

State / Province / Region *

Postal / Zip Code *

Country *

Phone Number *

###

####

Email *

If registering two persons list names of both here

Available Meals:

All Meals

Saturday lunch and dinner

Saturday dinner only

Sunday Breakfast

Saturday Lunch - Sandwich Platter $ 8.00
Saturday Dinner - $15.00
(Tri Tip and Chicken or Vegetarian Lasagne)
Sunday Breakfast $ 9.00

Saturday night dinner choice:

Tri Tip and Chicken

Vegetarian Lasagne

First time attendee to PNC ? *

Yes

Member of: *

Al-Anon

Guest

Service Position *

GSR

DCM

Area Committee Chair

Area Alt Chair

Area Chair

Alt Delegate

Delegate

Past Delegate

Trustee

Area

Name of Area Committee if Committee Chair

District

Other Info / Requests

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