Registration Form   KOS Fall Meeting
SEPTEMBER 20-22, 2013        Topeka, Kansas

Registrations will be accepted through September 18, payments for meals are non-refundable after September 18.

I (we) plan to attend the 2013 KOS Fall meeting.

Name(s)_______________________________________________________________

Address _______________________________________________________________

City, State, Zip __________________________________________________________

Phone _______________________ E-mail____________________________________

Registration Fee                                                         $20.00 x ____= $_________

(Waived for students 25 and under)

Saturday Banquet                                                      $20.00 x ____= $_________

Payment for banquet must be received by 9/18

Sunday Box Lunch                                                      $ 8.00 x ____=  $_________

Payment for lunch must be received by 9/18

Total Amount Due   (Checks payable to KOS)                                   $_________

(No refund for cancellations after September 18)

Number of persons in party: _______

Please mail completed registration with full payment to:
Terry Mannell, 218 Northridge Dr., Hays, KS  67601-1643

In submitting this registration form I (we) understand that KOS is not responsible or liable for any accidents or injury that might be associated with the 2013 KOS fall meeting.

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