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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