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Mail your Coffee donations
to Address below, Thank You !! ______ individual _______Group will donate _____ Gallons of Coffee @$24.00 per gal.______ $___________ Enclosed Please include Name, Address, and Phone.
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Please take the time to fill out
completely Please Print Mail Checks Payable to 52nd Michigan State Convention P.O. Box 1164 Belleville, Mi. 48112 Name ______________________________________ Area________ Address _____________________________________ City _________________
State____Zip__________ Phone (
)_______________ ______AA ______ Alonon
_____ Alateen _____ Guest _____ Hearing Impaired Specify other needs______________________________________________
Registration by 2/21/04 ____@ $10.00 each =____________________
After 2/21/04 ____@ $15.00 each = ____________________
Alateen -------------------- ____@ $5.00 each = ____________________
Saturday Banquet -------- _____@ $ 35.00 each = __________________
TOTAL = __________________
Reserved seating
available for banquet attendees(Saturday main speaker) |