Please print and return with your Registration     Deadline for Registration is April 26, 2010.

 

Name:  _________________________________________________ Phone # ________________________

 

Address:  ___________________________________________________________________________

 

Club/Circle/Council:  __________________________________ Email________________________________

 

¨ Check if you are planning to attend the Board Meeting, May 5, 2009, at 5:30 pm.

 

Please check all applicable designations:

¨ State Officer

¨ District Officer

¨ President: Club/Circle/Council

¨ State Chairman

¨ District Chairman

¨ Club Member

¨ Delegate

¨ Past State President

¨ Past District Director

¨ Visitor

¨ Alternate

 

Fill out registration form and mail along with your check in the amount of $30.00 before April 26,
 2010, made payable to Winter Haven Council of Garden Clubs and send to:
 

Jane West, 1125 North Lake Howard Drive, Winter Haven, FL 33881-3121 Phone 863-297-9387

 

PLEASE indicate SPECIAL MEDICAL/DIETARY NEEDS OR FOOD ALLERGIES ON LINES BELOW: