State Council Home

REGISTRATION

PRE-REGISTRATION FORM

Please complete this form even if you are not attending the optional activities to ensure you have a Name Badge upon your arival.

REGISTRANT'S NAME:
(PREFIX, FIRST, MI, LAST, SUFFIX):
LADY'S FIRST NAME (IF ATTENDING):
ADDRESS:


, IL
DAYTIME PHONE NUMBER:
EMAIL ADDRESS:
COUNCIL NUMBER:
REGISTRANT'S TITLE:
SPECIAL REQUESTS:
SECURITY CODE:
Enter the characters (case sensitive) that appear on the right into this box to complete your registration entries.
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