Registration and Meal Form

Name_________________________________ Telephone________________________

GFWC/CT Board Position ______________________ Email____________________________

Club_________________________________ District ____

Club Position __________________________ GUEST: _________________________________

Select one of the following for your luncheon choice:

( ) Breast of chicken

( ) Roasted loin of pork

( ) Grilled fresh atlantic salmon

• Please note any dietary restrictions: _____________________________________________

Registration: $4.00

Luncheon $25.00

For the luncheon and registration, make check out for Total payable to GFWC/CT and mail with this form to:

If check is for more than one reservation, please include all forms (one per person) in envelope.