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LLC-V |
Registration |
Name: ________________________________________________________
Badge Name: ___________________________________________________
Address: ______________________________________________________
______________________________________________________
City: _________________________ State: ___________Zip:_____________
Phone: (_____)_________________ email: ___________________________
| Quantity | Price | Total | |
| Full Registration | $75 | ||
| T-Shirts: sizes: S, M, L, XL | $15 | ||
| T-Shirts: sizes: 2X, 3X, 4X) | $20 | ||
| Total |
| Note: | Make checks and money orders payable
to "LLC-V" Mail registration must be postmarked by March 20th. There is a $10 cancellation fee. No refunds will be granted after March 30, 2000. |
___ I would like to volunteer. |
___ Send me/my organization ___ brochures. |
| ___ I need ASL services. | ___ Send me a presentation proposal guide. |
Club Affiliation: _____________________________________________
Mail To: |
LLC-V 5315 North Clark St. PMB 303 Chicago, Ill. 60640 |