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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:

___________________________________________________

LODGE:

_____________________________2011 OFFICE:

________________________

HOME ADDRESS: ____________________________________________________________ ____________________________________________________________ HOME PHONE:

_____________________WORK PHONE:

_____________________

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):

2011_fall_lc_reg_form  

The Grand Lodge, F.A.A.M., of Washington, D.C. 18980 Upper Belmont Place, Leesburg, Virginia 20176 LODGE: _____________________________2011...

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