Mail your Coffee donations to Address below

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.

Please take the time to fill out
completely                Please Print
               

Mail Checks Payable to

52^nd 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)
* Alateen permission
slips are required!!!