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142th Annual Convention Registration

 

142nd Annual National Convention
November 10 - 15, 2008

Crown Plaza Hotel
100 Berlin Road
Cromwell, CT 06416
Reservations (800) 308-4589 or (860) 635-2000

 

 
Personal Information (Please Print Clearly)
Name: ______________________________________________________________________________
  first convention Past Delegate Youth Junior
Additional Names: ____________________________________________________________________
  first convention Past Delegate Youth Junior
Additional Names: ____________________________________________________________________
  first convention Past Delegate Youth Junior
Address: ____________________________________________________________________________
City: ________________________________________ State: ___________ Zip: __________________
Phone: ( _________ ) _______________________________________
E-mail Address: ____________________________________________
Grange Name and No: _____________________________________ State Grange: _______________
 

Functions and Events
   
Date
Time
Function
Cost
Number
Total
N/A
N/A
Convention Registration
$25.00
_________
$ _________
11/11
12:15
p.m. Luncheon with Speaker
$23.00
_________
$ _________
11/12
8:00
a.m.Salute to Agriculture Breakfast
$20.00
_________
$ _________
11/12
12:15
p.m Luncheon with Speaker
$23.00
_________
$ _________
11/13
9:00
a.m. Tour (includes hot lunch)
$25.00
_________
$ _________
11/13
12:30
p.m. Past Delegates Luncheon
$23.00
_________
$ _________
11/13
6:00
p.mYouth Pizza Party (All Welcome)
$12.00
_________
$ _________
11/13
1:30
p.m Junior Tour
$8.00
_________
$ _________
11/14
12:15
p.mGROW Club Luncheon
$21.00
_________
$ _________
11/15
8:00
a.m. Junior Breakfast & Super JG Award Recognition
        Adult
$15.00
_________
$ _________
        Child (2 - 10)
$8.00
_________
$ _________
11/15
7:00
p.m Celebration Banquet      
        Adult
$32.00
_________
$ _________
        Child (2 - 10)
$17.00
_________
$ _________
Total - Functions and Events
$ _________
Convention Sales Items
     
Cost
Quantity
Total
Convention T-Shirt (S-XL)
$15.00
_________
$ _________
Convention T-Shirt (2X-3X)
$15.00
_________
$ _________
Convention Pin
$5.00
_________
$ _________
    Total - Convention Sales Items
$ _________
    GRAND TOTAL (Functions + Convention Sales Items)
$ _________

Payment Information

 

I have included check number _______ in the amount of $_________ as payment for my National Grange Convention Registration
Please charge my credit card (National Grange accepts Visa, Master Card and Discover) for payment of my National Grange Convention Registration.
Visa
MasterCard
Discover


Credit Card #______________________________________________________Exp. _______________

Name as it appears on Card

Name ____________________________________Signature___________________________________
 

*Please Note:

Convention Registration is $25 per person. You must register for Convention for admittance to all meetings and activities, including the Evening of Excellence and Seventh Degree Conferral.

This is a registration form for convention activities only. Hotel reservations must be made separately. Juniors do not have to pay the registration fee.

First Name, Last Name, Grange Name, Grange Number and State will be printed on name badges. If multiple people are registering on the same form, please make sure all the information corresponds to each person correctly.

Meal tickets will not be mailed. They will be available for pick up at the convention office.

Make checks payable to the National Grange.

Mail Convention Registration to:
Fax Convention Registration to:

 

 

National Grange
Attn: Convention Registration
1616 H Street, NW
Washington, DC 20006

 

 

202-347-1091
DEADLINE TO MAIL OR FAX CONVENTION REGISTRATION TO IS OCTOBER 10, 2008
 

NATIONAL GRANGE OF THE PATRONS OF HUSBANDRY
1616 H Street NW • Washington, DC 20006
(888) 4-GRANGE • (202) 628-3507 • Fax: (202) 347-1091
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