The Grand Lodge, F.A.A.M., of Washington, D.C.
2011 FALL LEADERSHIP CONFERENCE September 10 - 11, 2011 The National Conference Center www.conferencecenter.com
18980 Upper Belmont Place, Leesburg, Virginia 20176
REGISTRATION FORM ************************************************************************************ Step 1 – Please complete the form below taking care to PRINT LEGIBLY and return by July 15, 2011. Step 2 - Please mail, fax, or scan and email your completed form to the Office of the Grand Secretary: Address: Grand Lodge of DC, 5428 MacArthur Blvd, NW, Washington, DC 20016-2524 Fax: (202) 686-2759 Email: grandlodge@dcgrandlodge.org QUESTIONS? Contact the Grand Lodge office at (202) 686-1811
************************************************************************************************************ NAME:
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LODGE:
_____________________________2011 OFFICE:
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HOME ADDRESS: ____________________________________________________________ ____________________________________________________________ HOME PHONE:
_____________________WORK PHONE:
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E-MAIL ADDRESS: _____________________________________________ In case of emergency, contact (Name and Phone): ______________________________________ The information below is required to assure that adequate accommodations are made for Conference attendees:
Please choose one: [
] Saturday and Sunday - Full Program with Overnight Stay (8 AM arrival, includes lunch & dinner on Saturday, breakfast & lunch on Sunday, and overnight accommodations) [ ] Saturday and Sunday - No Overnight Stay (8 AM arrival each day, includes lunch & dinner on Saturday, breakfast & lunch on Sunday) [
] Saturday Only (8 AM arrival for daytime program – includes lunch & dinner)
[
] Sunday Only (8 AM arrival for morning program – includes breakfast & lunch)
Please list any special dietary or other arrangements (if needed):