LEGISLATIVE DAY REGISTRATION FORM

MISSOURI STATE CAPITOL

JEFFERSON CITY, MO
TUESDAY, MARCH 13, 2018

TIME: 8:30AM TO 2:00PM. You will be free to visit Representatives and Senators at
2:00PM.

Cost: Adults $25, Youth 18 & under $15. This includes rolls, coffee and a lunch with
drinks. Breckenridge Scholars are paid by their sponsoring club.

Preregistration deadline is Wednesday, March 7, 2018. After March 7 registration will be

$30.

Please send this form and cash, or a check, (made out to MoFRW) to Nancy Johnson PO
Box 412, Hermitage, MO 65668.

Name________________________________________________________________________

Address______________________________________________________________________

Name of your club____________________________________________________________

MO District______________________Email_______________________________________

Phone___________________________Special Dietary Need________________________

——————————————————————————————————————————

Guest: Someone not belonging to a Republican Club.

Name________________________________________________________________________

Address______________________________________________________________________

Email____________________________Phone_______________________________________

Special Dietary Need__________________________________________________________

Total amount enclosed. $________

Questions: Debbie Phillips (phone) 660-678-4221, (cell) 660-624-2522, heet2@iland.net