Lecturer and Community Service Conference Registration Form

							Lecturer and Community Service Conference Registration Form
March 28, Wayne Grange, 6491 Mt. Gilead Rd, Fredericktown
Cost $12.50 per person
Name _________________________________________ Grange __________________ County __________________

Address _____________________________________________________ City __________________ State _________

Zip _______________Phone (_______) _____________________ E-mail ____________________________________


Name _________________________________________ Grange __________________ County __________________

Address _____________________________________________________ City __________________ State _________

Zip _______________Phone (_______) _____________________ E-mail ____________________________________

Mail registration and check (payable to Ohio State Grange) by March 14 to:
Ohio State Grange, 16303 Village Parkway, Fredericktown, Ohio 43019