Pre-registration Form
LOS 2009 Annual Meeting October 30-31
Cameron, Louisiana

Name(s)_____________________________________________________________
Address ________________________________________________________________
 
Email: ____________________________________ Phone: ______________________
 
Number registering for meeting:                              _____at $10.00/person = $________
Number for chicken/sausage gumbo dinner         ______ at $6.00/person = $_________
This will be a fund raiser for the local 4H club.
Dues                                                                                                        $__________ enclosed
Total                                                                                                        $__________ enclosed
 
Please make check payable to LOS, and mail to: Judith O'Neale, 504 Whitebark Drive, Lafayette LA 70508, phone 337-981-1011, jloneale@aol.com
 

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