Registration Information

Please print all information clearly.  Mail this form & check or money order made out to the RICHARD III SOCIETY.  Do not send cash or dues.  Address envelope to:  MRS. ROSE WIGGLE, AGM REGISTRAR, 22153 FRANCIS, DEARBORN, MI 48124.  Please circle your meal preference and include advance raffle ticket selection form and payment.  Registration must be received by September 25th.  Registration at door as space permits.  AGM Registration fee includes Friday night Reception & movies, Saturday Continental Breakfast & Luncheon, Workshops, Dance lesson

Name(s) _____________________________________________________________________________
Address _____________________________________________________________________________
City/State/Zip ________________________________________________________________________
Telephone ________________________________ E-mail _____________________________________
 
Amt.
X
Quantity
=   Total
Registration fee
$ 65.00
   __________ $_______
Saturday Night Banquet
$ 40.00
  
__________
$_______
Circle one:  Prime Rib au jus      Roasted Salmon Filet      Vegetarian
Schallek Breakfast
$ 20.00
   __________ $_______
Greenfield Village Tour  
$ 20.00
   __________ $_______
Raffle Tickets
$ 1.00 ea. Or 6 for $ 5.00
   __________ $_______
Grand prize ticket
$ 5.00 ea. Or 3 for $10.00
  __________ $_______



 

   
Total Enclosed
$_________