Registration Form
KOS Fall Meeting

October 2 - 4,  2009
Hutchinson, Kansas

I (we) plan to attend the 2009 KOS fall meeting

Name(s)_______________________________________________________________

Address  _______________________________________________________________

City, State, Zip __________________________________________________________

Phone _______________________  E-mail____________________________________

 
Registration Fee                                    $15.00 x ____=   $_________

Saturday Banquet                                  $20.00 x ____=   $_________

Sunday Box Lunch                                   $7.00 x ____=   $_________
   

Total Amount Due                                                             $_________

Registrations received after September 15 will be $20. 
Students will pay a $5 registration fee unless they are presenting.

Make checks payable to :  KOS

Please mail completed registration to:
Terry Mannell
218 Northridge
Hays, Kansas 67601

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 2009 KOS fall meeting.


_______________________________________________________________________
 

_______________________________________________________________________
Signatures                                                                                 Date

(attach additional names and signatures as necessary)

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