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Please print off and mail in along with your Check or Money Order made payable to Janie Rausch in the amount of $65.
Send to Janie Rausch, 1717 E. Cielo Grande Avenue, Phoenix, AZ 85024

 

 

AZ State RH Convention - 2006 Registration Form
Fun, Friendship and Frolic on our Fifth

Saturday – January 28, 2006

(Please complete all lines and print clearly to ensure correct name badge is correct.)

Name ___________________________________________________

Chapter _________________________________________________

Address _________________________________________________

City ________________________ State _______ Zip ____________

PHONE # _________________E-Mail _________________________

Signature ____________________________ Date _______________

QUEEN MOTHER’S NAME ____________________________________