2011 IOWA D.A.R.E.
July 31st, August 1st and 2nd
Name: ________________________________Phone: ___________________________
Department Name: ______________________E-mail: ___________________________
__________ Total number of GUESTS attending family reception and dinner
Sunday night at the Country Inn
__________ Total number of GUESTS attending awards luncheon Monday at
11:30am at Luther College (guest tickets are $20.00 per guest)
__________ Total number of GUESTS attending lunch on Tuesday at 12:00 at
Luther College (guest tickets are $10.00 per guest)
Conference fee: $50.00 for your membership in the Iowa D.A.R.E. Association. Please
make checks payable to the Iowa D.A.R.E. Association.
__________ Membership fee included with registration
__________ Payment will be made at conference site
Free D.A.R.E. Iowa polo shirt with your registration if received by July 1st:
Men___ Ladies___ ___S ___M ___L ___ XL ___2XL ___3XL ___4XL
Please make hotel reservations at the Country Inn 563-382-9646. Sunday and Monday
nights hotel costs are paid for by the IOWA D.A.R.E. Board! Additional rooms at the
Quality Inn 563-382-2269.
Send Registration to: Vern Vacek 17846 Rainbow Dr. Monticello, IA 52310 or e-mail