CONFERENCE REGISTRATION FORM

Gathering of the Green... March 6, 7, 8 & 9, 2002 -- Moline, Illinois
Primary Registrant - Please provide the following information about yourself. In each box at right, indicate the # of activities in which you'll participate. (Note: You may wish to purchase more than one hat or pin.) Conf.
Regis.
$15		 Bnqt.
$19		 Amana
$21.50		 Quad
$18		 Hats
$12		 Pins
$10
NAME
STREET ADDRESS
CITY, STATE, ZIP
PHONE (Incl.area code) The Registration Deadline
E-MAIL ADDRESS is February 15, 2002
CLUB NAME

List the names and city, state for others registering with you. In each box at right, indicate the # of activities in which each registrant will participate. (Note: Some may wish to purchase more than one hat or pin.) Conf.
Regis.		 Bnqt. Amana Quad Hats Pins
Name City, State $15 $19 $21.50 $18 $12 $10
Club name
Club name
Club name

Total # of Conf. Registrations




Total # of Banquets




Total # to Amana Bus Tour/Lunch- 3/7




Total # to Quad Cities Tour/Lunch - 3/8




Total # of Hats




Total # of Pins




Prices per category: x$15 x$19 x$21.50 x$18 x$12 x$10
Total $ per category:
GRAND TOTAL ENCLOSED: Make checks payable to "Gathering of the Green"

Complete and return this form to:
 Kenneth Reese
6829 Burning Tree Circle
McHenry, IL 60050
If the 3/7 Amana Tour and/or the 3/8 Quad Cities tour fill up quickly, alternate tours will be scheduled. Would you consider these alternates? (Mark yes or no in the boxes)
Amana - 3/8
Quad Cities - 3/7

    Due to the fact that the text font sizes may be set up differently on YOUR browser, it is difficult to design a "form" that will print the same size on everybody's computer. If you have any information that will not FIT on this form, please pencil it in ANYWHERE on the paper, even on the BACK. Ken would like to PREPRINT your hometown and club name on your name badge and on the badges of ALL the participants, so please include that information for yourself and everyone who is coming with you.

Thanks!
Meli (Web site staff)




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