BULLSHIPPERS PRE-REGISTRATION

Complete the form below and mail it, along with $20.00 registration fee to:

Jim Parks
4305 Best Ave.
Titusville, FL 32780

Deadline is May 15, 2012. On site registration will be $25.00. Your cards will be typed up and logged in. Pick up your cards by presenting your Elks card, then get your ribbons, bar, bolo and hat. Cards only for those not attending the convention is $5.00.

NAME __________________
LODGE NAME _____________ NUMBER ____ STATE __
ADDRESS _______________.
CITY STATE _________________________
EMAIL ADDRESS______________________________________
[ ] Past Bullshipper President (year) ______________
[]Bullshipper Officer (Title) ____________________
[ ] Bullshipper (year joined) _______________
[ ] Will join the Bullshippers in 2012

Email Address_________________________________________________________

( Play in Golf Tournament Yes___ No ___)