FLORIDA SHRINE ASSOCIATION
2002 CONVENTION REGISTRATION FORM
MAY 1-4, 2002
Jacksonville, Florida
Temple: ________________________ Location: ___________________________
Room Deposit Must for First Night
Must be sent to the Hotel of Choice
DO NOT SEND ROOM DEPOSIT WITH THIS REGISTRATION FORM
Indicate FSA 2002 Convention when making room reservations
RETURN $10.00 CONVENTION REGISTRATION FEE WITH THIS FORM ONLY
Last Name: ________________________ First Name: _______________ MI: __
Address: _____________________________________________________________
City: ________________________________ State: _____ Zip: ____________
Telephone:_______________ Email: ____________________________________
If Two or More Sharing Room Fill in ALL Names:
1. ___________________________________________________________________
2. ___________________________________________________________________
3. ___________________________________________________________________
Arrival Date: __________ Departure Date: ___________ Total Nights: ___
In Case Of Emergency:
Contact: ____________________________ Phone No: ______________________
Unit or Title: _________________ Parade: Y _ N _ Compete: Y _ N _
Other Comments: ______________________________________________________
This form should be given to your temple's Recorder or Housing
Chairman along with your registration fee, they will send it no
later than April 1, 2002, to:
Bill Rouse, Housing Chairman
Florida Shrine Association
P.O. Box 350662
Jacksonville, Fl 32235-0662
Questions? Call Convention Housing Chairman Bill Rouse
Phone: (904) 646-4482
Email: gkrouse@aol.com
Web: http://fla-shrine.org/fsa2002
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Below for ___________ Temple Use Only
Date Received: _____________ Check No: _____________ Cash
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Last update: March 11, 2002