Annual Meeting Registration (Individual)

First Name*

Last Name*

Spouse/Partner First Name

Spouse/Partner Last Name

Home Phone*

Work Phone

Email*

Business / Organization

Annual Meeting Registration (Individual)	$25.00

Registration Total:	$25.00

Address*

City*

State*

Zip Code*

Credit Card*

Card Number*

Expiration Date*

Security Code*

I would like to cover all processing fees ($0.87)

	(785) 263.1863
	info@communityfoundation.us
	PO Box 735, Abilene, KS 67410