Page 27 - MFM May 2015 C

149th Annual Communication
GRAND LJOuBnDoeGz2eE5m,Aa2Fn6,,&&MAo2Mn7t,a2on0fa1M5ONTANA

PRE-R1E49GtIhSATnRnAuTaIlOCNomMmauilntihciastiFoonrm to:
PO Box 1158

Helena, MT 59624-1158

Registration must be Received prior to June 1, 2014

PLEASE TYPE OR PRINT: (Name Badge Will Be Completed From This Information)

NAME: ______________________________________________TITLE: _____________________________
(Full Given Name) (Title - WM, Sec, Trs, PM, MM)

NAME OF LODGE: ____________________________________________ LODGE NUMBER: __________

MAILING ADDRESS:_________________________CITY: ________________STATE: _____ZIP:________

TELEPHONE: _____________E-MAIL:____________________ACCOMPANIED BY:__________________

(Lady’s Name)
Please complete the top section and mail it in even if you do not plan to purchase any meals.

Tickets are limited and availability is not guaranteed after June 1st

Friday, June 26, 2015
LMaedni’ess&LuLnucnhcehoeno n (H ambu rger B ar) No. ____ @ $18.00 = $ ______
Delegates (& Ladies) No. ____ @ $27.00 = $ ______
Banqueotr(L(oSnadlmononB)r oil) NNoo.. ____ @ $38.00 = $ ______
____ @ $38.00 = $ ______

Saturday, June 27, 2015 No. ____ @ $20.00 = $______
MReecne’sptLiounncfhoeroGnra(nTdraMil aRsitdeer L&unGcrhaenodnLBoadrg- echOicfkfiecne,rsp ork , sa lad) No. ____ @ $23.00 = $ _____

(assorted hor d’oeuvres)

Payment for Activities: Total Activity Amount: $________
Check Enclosed: #____________________________

(Please make checks payable to: 149th Annual Communication)

Credit Card (Master Card or Visa Only): _______________________ Expires: __________
SIGNATURE: ____________________________________________________

Registration/Credentials and Session will be at the Holiday Inn (5 E Baxter Lane)
The “Session” will be held at the Holdiay Inn

Your curIrfeanttteanudtihnograizseadPGrorxayndYoLuomdguestDpureesseCnatrtdheisPrreoqxuyiCreadrdtowbheenpryeosuenstigend aint SanesdsiRoengiRsteegristration
General Member Registration Form
Page 27