California Federation of Republican Women

2011 Fall Board of Director's Convention Registration FormOctober 21-23, 2011 Visalia, CA Marriott HotelName CFRW Title Divison TitleDivision Club County/RegionAddress City Zip CodePhoneEmailType names as they should appear on name badgesAttendeesDelegateType*CP/ BD/CDCFRW Title Division Title Club TitleReg.Fee$45Sat.Lunch$25Sat.Banquet$50TotalConf.$120GuestsINSTRUCTIONS:IF YOU HAVE SPECIAL DIETARY NEEDS, PLEASE NOTIFY US. $ - $ - $ - $*Delegate Type: CP - Club President, BD - CFRW Board, CD - Club DelegateGRAND TOTAL ALL PAGESIf you need more space, make a copy of this form before completing.Mail form W/check to: "CFRW Fall Convention" (no registration without payment accepted) Late Charge of $25 assessed for registrations received after 10/6/11Elizabeth Hart, CFRW Fall Convention Registrar Phone: 209-523-1328200 W. Roseburg Ave. No registrations accepted after 10/15/11Modesto, CA 95350