Central Iowa Orchid Society
Speaker's Day, July 27th, 2019
Registration Form

To help us plan for Speaker's Day, we encourage you to fill out this registration form and return it to: Central Iowa Orchid Society, c/o Chris Barck, 418 Lucinda Street, Perry, IA 50220. We would like these returned by July 12, 2019 if possible.

Please make checks payable to the Central Iowa Orchid Society.

$30.00 per person ($35.00 at the door).

Name:__________________________________________Telephone:________________________

Address:_____________________________________City:________________________________

State:__________________________________________Zip Code:_________________________

Number of people attending: _____________ Email:_____________________________________

Amount Enclosed: $____________ or: Name on Credit Card: _____________________________

Credit Card # ___________________________ Exp. Date: MO____ YR____ Security code: _____