Annual Meeting Registration (Couple)

First Name*

Last Name*

Spouse/Partner First Name

Spouse/Partner Last Name

Home Phone*

Work Phone

Email*

Business / Organization

Annual Meeting Registration (Couple)	$50.00

Registration Total:	$50.00

Address*

City*

State*

Zip Code*

Credit Card*

Card Number*

Expiration Date*

Security Code*

I would like to cover all processing fees ($1.44)

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