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REGISTRATION
113TH NATIONAL CONVENTION
JULY 17 – 20, 2019
BETA NU CHAPTER
KOKOMO, INDIANA
Member Name ________ PNP ( ) Spouse’s Name PNS ( )
Chapter _______ Phone
Address _______________ City____________________ State Zip ________
Children (Names & Ages) Adult Guest(s)
Email Address _____________________________
EVENT AMOUNT PER PERSON NUMBER ATTENDING TOTAL $
Member Registration $140.00 (Member & Spouse)
$20 Additional if Postmarked after
June 30, 2019
$70.00 Each Single
$10 Additional if Postmarked after
June 30, 2019
Golf Outing/Bowling
Friday 7/19 Please Indicate if Participating
Pay at Registration
Price TBD
Ladies Luncheon
Thursday 7/18 Not Included in Registration fee
$25.00
BAR-B-Q
Thursday 7/18 Included in Registration Fee
Guest $15.00
Held at Beta Nu Chapter House
President’s Ball
Friday 7/19 Included in Registration Fee
Guest $15.00
Held at Shriner Banquet Hall
Awards Banquet
Saturday 7/20 Included in Registration Fee
Guest $30.00
Held at Shriner Banquet Hall
Will you use Shuttle Service Yes No Grand Total $ _____
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