REGISTRATION FORM
WyCB 2018 State Convention

 
NAME(s)_______________________________________________  
              _______________________________________________
 
ADDRESS_____________________________________________
            
CITY_________________________STATE/ZIP________________
 
PHONE________________________________________________

 
PREFERRED PROGRAM FORMAT

LARGE PRINT______     BRAILLE______ STANDARD______

______ Please indicate if you will be needing transportation in Casper.

 

LUNCH ENTREE SELECTION - ENTER DESIRED #

______  BAKED HAM
 
______  CHICKEN CORDON BLEU
 
______  QUINOA STUFFED PEPPER  (vegetarian and gluten-free)
 
The convention registration fee of $25 per person covers refreshments, lunch and all convention materials.  
 
Please mark your selections above.  Mail completed form along with your check made payable to “WYCB” to:

Ilene Whiteley, Treasurer
PO Box 433
Evansville, WY 82636
 
Fee for registrations received after June 6 and prior to June 19 will be $40.