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REGISTRATION FORM GFWC Great Lakes Region Conference

Dayton Marriott

1414 S. Patterson Boulevard Dayton, Ohio 45409

(937) 223-1000 Fax (937) 223-7853

October 15, 16, 17, 2010

N a m e _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Address

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

C i t y _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

State______________________Zip___________

$

__________

$

__________

$

__________

$

__________

Phone (____)______________________

Friday - Ohio State Night

$28.00

Saturday Lunch

$21.00

Saturday Dinner

$28.00

Sunday Brunch

$20.00

Officer/Chairman

___________________________

Registration

Club/District/State Affiliation

___________________________________________________

$15.00 $

__________

Mini Mart Space

$10.00

$

__________

Friday Tour-(8:15 a.m.-2:30 p.m. or 2nd

bus 3:30 p.m.)

Motor Coach to Air Force Museum tour “Women in Flight” Tour and lunch at Victorian mansion/Tour Carillon Park

$35.00

$

____________

Soup

Choice ½ Sandwich

Ham

______

Turkey Breast

______

Vegetarian

_______

Plus beverages and dessert Total Enclosed

$

__________

Please indicate any dietary restrictions

__________________________________________

********************************************************************************************************** Make checks payable to:

GFWC/Ohio Federation of Women s Clubs

Send Registration with check to:

Patrice Booze, GLR Registration Chairman 10359 Fields-Ertel Road, Loveland, Ohio 45140-1811

Boozesails@aol.com

513-683-9471

Registration must be received by September 23, 2010. No refunds after October 5, 2010

Any questions? Please contact Conference Chairman Rose Logston at 740-423-8715. Please duplicate this form for each person attending.

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