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</o:shapelayout></xml><![endif]--></head><body lang=EN-US link=blue vlink=purple><div class=WordSection1><p class=MsoNormal>Greetings Everyone,<o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal>Please find the pre-registration form for the NFB of Kentucky State Convention directly below:<o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal>PRE-REGISTRATION APPLICATION<o:p></o:p></p><p class=MsoNormal>NFB of Kentucky State Convention<o:p></o:p></p><p class=MsoNormal>September 30, October 1st, & 2nd, 2016<o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal>This application should be completed and returned to Mike Freholm, 2012 Harris Way, Russell, KY 41169 no later than Monday, September 19, 2016. Make your check or money order payable to NFB of Kentucky.<o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal>REGISTRATION ($15.00) TOTAL<o:p></o:p></p><p class=MsoNormal>Number_______ $________ <o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal>Name(s)___________________________________________________<o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal>Address___________________________________________________<o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal>City______________________________State____Zip____________<o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal>Phone_____________________________<o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal>Luncheon and Banquet tickets are included in the price of registration for those who are current members, and who have pre-registered by September 19th.<o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal>LUNCHEON Non-member $18.00<o:p></o:p></p><p class=MsoNormal>Number Attending______ <o:p></o:p></p><p class=MsoNormal>Regular__________ <o:p></o:p></p><p class=MsoNormal>Vegetarian________<o:p></o:p></p><p class=MsoNormal>Gluten Free_______<o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal>Banquet Non-member $30.00<o:p></o:p></p><p class=MsoNormal>Number Attending _____ <o:p></o:p></p><p class=MsoNormal>Regular _________ <o:p></o:p></p><p class=MsoNormal>Vegetarian_____<o:p></o:p></p><p class=MsoNormal>Gluten Free_____<o:p></o:p></p><p class=MsoNormal> <o:p></o:p></p><p class=MsoNormal>CHILDCARE <o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal>NOTE: You must enroll your child(ren) by September 4, 2016. If we do not have at least three (3) children committed to using childcare we will not be able to offer the service. A $10 non-refundable payment must accompany this form for each child you wish to register. Your money will be refunded if we do not sign up at least three children. <o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal>CHILDCARE ($10) <o:p></o:p></p><p class=MsoNormal>Number of Children $_________ <o:p></o:p></p><p class=MsoNormal>Child(ren) Name-------------------------------------------------<o:p></o:p></p><p class=MsoNormal>----------------------------------------------------------------------------------------------------------------- <o:p></o:p></p><p class=MsoNormal>Parents Name___________________________ <o:p></o:p></p><p class=MsoNormal>Phone Number___________________________<o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal>RAFFLE TICKETS ($10.00)<o:p></o:p></p><p class=MsoNormal>Number Sold_________ $__________<o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal>DONATION $__________<o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal>TOTAL ENCLOSED $__________<o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal><o:p> </o:p></p></div></body></html>