|
Name:
Email Address:
Address (please be sure to include city, state, and zip code):
Phone - day:
Phone - evening:
Chapter Name:
Are you a chapter board member? If so, what position do you hold?
Registration fee enclosed: _________$65.00 Sts. Peter and Paul Retreat House
_________$25.00 area hotels
_________$25.00 spouse attending Friday banquet
Other:
How long have you been volunteering for NIN?
How many conventions have you attended?
Please provide us with the following information:
Arrival:
Mode of Transportation:
If staying at hotel – rooming with:
Please list special dietary needs that you may have:
|