Sign me up for CCI’s Statewide
Convention
Saturday, July 17, 2010 Hilton Garden Inn, Johnston
Print the form below, fill it out and mail it with your check (made payable to Iowa CCI) or credit card information to:
Iowa Citizens for Community Improvement
2001 Forest Avenue
Des Moines, IA 50311
Your Information:
Name(s) of people attending:
_______________________________________________________
Address: ________________________________________________
Town/State/Zip: __________________________________________
Phone: _________________________________________________
Email: __________________________________________________
I heard about CCI's convention from: _________________________
Registration:
By 7/4 After 7/4
Per Person regisration __ $35 __ $45
I'd like to sponsor the convention with an addition gift of:
__ $500 __ $250 __ $100 __ $50 ___Other
Total # of people attending:
________________
___ Yes, I/we'll be there for the Friday night pre-party, too!
Total amount enclosed: $________
___Check or ___Credit card
Mastercard___ or Visa___
Card Number: __________________
Expiration Date: ___Month ___YearCVV2 code (3 digit on back): ____
Signature: _____________________
Print the form, fill it out and
mail it with your check (made
payable to Iowa CCI) or credit card information to:
Iowa Citizens for Community Improvement
2001 Forest Avenue
Des Moines, IA 50311