CENTRAL STATES ASSOCIATION OF SHRINE MOTOR CORPS

MID-WINTER MEETING EVENTS ORDER FORM 2003

FRIDAY APRIL 11        Cocktail Party - Sesostris Shrine Center
                                        5:00 - 6:30 PM
                                        Number attending____@ $10.00 per person $_______

SATURDAY APRIL 12
                                        Ladies tour, lunch and shopping
                                        Number attending____@ $10.00 per person $_______

                                        Banquet and Installation of Officers
                                        Number attending____@ $17.00 per person $_______

                                                                           TOTAL ENCLOSED  $_______

Please Send this form to:

Jerry Ritchey
President C.S.A.S.M.C.
13300 West Bluff Road
Malcomb, NE 68402