Name ____________________________________________________
Address ___________________________________________________
City, State, Zip ______________________________________________
Membership Number (s) ______________________________________
No. Of persons ________@ $40.00 per person $_______________total
$5.00 Late Fee Applies after 5-1-08 Per Registration
Included in the price of registration is a buffet at the Social Hour on
Friday night and your Banquet dinner on Saturday night. Please indicate
your Banquet Dinner Choice:
______Center Cut Top Sirloin Steak, _______Chicken Breast Supreme, or
______Deep Fried Jumbo Shrimp.
Please Note:
all above dinners include potato, vegetable, salad, rolls, coffee and
dessert.
Please make checks payable to
NDPCS
and return check and registration form to:
Clifton and Joyce Peterson, 2132 17th Ave. NW, Ruso, ND 58778
Thank You & See You at the Convention!