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Name_______________________________ |
Nickname ____________________________ |
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Position/Title _________________________ |
USD/Interlocal # ______________________ |
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Address _____________________________ |
USD/Interlocal Name __________________ |
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____________________________________ |
Firm _______________________________ |
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____________________________________ |
Telephone ___________________________ |
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Spouse/Guest ________________________ |
FAX _______________________________ |
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1997-98 KASBO Dues (Ignore if dues already paid) $10 |
$_________________ |
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Convention Registration: |
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Postmarked/FAXED & paid on or before April 15, 1998 $100 |
$_________________ |
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Registration and/or payment after April 15, 1998 $125 |
$_________________ |
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Includes: Thursday Breakfast, Lunch, Banquet and Friday Lunch |
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Cosmosphere Event (Wednesday) Not included in registration $30 |
$_________________ |
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Pre-Convention Workshops (Wednesday, 2:00 - 4:00) |
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$_________________ |
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$_________________ |
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$_________________ |
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Pre-Convention Tours (Wednesday, 2:00 - 4:00) |
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_____________ |
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_____________ |
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Guest Tickets (Please include number of tickets needed) |
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$_________________ |
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$_________________ |
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$_________________ |
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$_________________ |
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$_________________ |
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$_________________ |
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______Check Enclosed (Payable to KASBO) |
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______District Purchase Order Enclosed |
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Return Registration Form with Check or PO to:
KASBO, RR 1- Box 17, Alexander, KS 67513
FAX 316.525.6368
Please copy this document to use as your invoice if you are sending a Purchase Order