State Convention Form

NARFE TAOS CHAPTER 1401
TAOS, NM

* designates Fields that ALL ATTNEDEES need to fill out.
If you are not attending the Banquet, place a ZERO there and in the menu selection box.
If your Cell Phone is your Only Phone, please fill that out in place of the home phone block.

NARFE MEMBERSHIP NUMBER:*
FIRST NAME AND INITIAL:*
LAST NAME:*
MAILING ADDRESS (PO OR STREET):*
CITY/STATE/ZIP
HOME PHONE NUMBER:*
CELL PHONE NUMBER:
TOTAL CHARGING:*
NUMBER ATTENDING:*
CREDIT CARD: Do not fill out until site secure
Please include any special instructions for your attendance:
EMAIL ADDRESS:
DELEGATE: Yes or No*
# ATTENDING BANQUET:*
STATE BEEF OR CHICKEN FOR ALL ATTENDEES:*

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