Please print and fill out form, enclose $50*** check, then mail to:
Steve and Dorothy Benthine:
414 E. Greenwood St.
Springfield MO 65807

MEMBER NAME:______________________________________________________________________________________

SPOUSE OR GUEST NAME:______________________________________________________________________________

ADDRESS____________________________________________________________________________________________

CITY____________________________________

_____STATE:______________________ZIP:______________________

CELL #___________________________________________EMAIL____________________________________________

POLO SHIRT SIZE (MEMBER ONLY) SMALL________ MED________ LRG________ XL________ XXL________

BATTERY________ JOB:___________________________ DATES:_____________________________________________

NUMBER FOR DINNER ($31.50 PP** ________________ TOTAL: ______________________________________

***$50 COVERS SOME OF THE COST FOR ; meeting room, shirts & hats, welcome bags, gifts, reception food & drinks.

**$31.50 Dinner cost inckudes choice of Beef Tips. Glazed Ham, Fried Chicken, or
House Salad and Vegtables, Mahed Potatoes, Apple Cobbler, w/icecream, Coffee and Tea