NC DIVISION 111th ANNUAL CONVENTION
Holiday Inn - Rocky Mount
651 Winstead Avenue Ext.
October 3-6, 2007
Send Registration Form to Convention Treasurer by September 15, 2007 to:
Bethel Heroes 636, UDC
PO Box 64, Nashville, NC 27856
Make Check payable to: Bethel Heroes 636
NAME: _______________________________________________________________________________________________
ADDRESS: ____________________________________________________________________________________________
CITY, STATE ZIP: _____________________________________________________________________________________
PHONE – Home: ________________________________ Work: ________________________________
CHAPTER NAME: _____________________________________ CHAPTER CITY: ______________________ __________
Please check applicable box/boxes below:
( ) General Officer…Current Office ____________________________________
( ) Ex General Officer…Office Held ____________________________________
( ) Honorary President General
( ) Division President
( ) Honorary Division President
( ) Division Officer…Current Office ____________________________________
( ) Past Division Officer…Office Held __________________________________
( ) Division Committee Chairman…Committee ___________________________
( ) District Officer…Current Office ____________________________________
( ) Chapter President
( ) Delegate
( ) Alternate
( ) UDC Member
( ) Real Daughter
( ) Granddaughter
( ) Great-granddaughter
( ) Great-great-granddaughter
( ) SCV Member ( ) C of C Member ( ) Guest ( ) Other _________________
( ) Registration Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $15.00 ________________
( ) Welcome Banquet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $35.00 ________________
Grilled Pork Chops or Chicken Marsala, please circle choice
( ) 2007 Luncheon. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $25.00 ________________
Croissant filled with Chicken Salad or Stir Fried Veg. over noodles, please circle choice
Total $________________
This form may be duplicated as many times as necessary for members.