LOUISIANA GRAND ASSEMBLY 2010 REGISTRATION FORM
REGISTRATION IS REGISTRATION $10.00 PER
PERSON FOR GIRLS, ADULTS AND VISITORS.
ALL PERSONS ATTENDING INFORMAL OPENING AND INSTALLATION MUST REGISTER
BUT DO NOT HAVE TO PAY REGISTRATION FEE.
DUES CARDS/PARENT CARDS MUST BE PRESENTED TO THE REGISTRATION CHAIRMAN
UPON ARRIVAL AT GRAND ASSEMBLY. PLEASE
PRINT LEGIBLY. MAKE COPIES AND USE
ADDITIONAL PAGES AS NEEDED.
Return forms and fees payable to
Cybble Bucceri, Registration Co-Chairman
3812 General Meyer, New Orleans, LA
70114
504-361-0997, Cybble@jackstumpf.com
ASSEMBLY:
______________________________________
MOTHER
ADVISOR/DESIGNEE:
NAME TITLE AMT
PAID/Comp.
ASSEMBLY NAME AND
NUMBER:____ _
MOTHER ADVISOR:___
TOTAL NUMBER REGISTERED: __ _____ TOTAL AMOUNT PAID: __$___________
CHECK NO: ______________
(Use additional sheets if needed)