Registration Form
NCPHS Fall 2008 Valdese Tour – October 11, 2008

Name(s): _________________________________________________

Address: __________________________________________________

City: ___________________________ State/Zip: ________________

Telephone: _____________________________

Email: ____________________________________________________

No. of registrations ____ @ $17.50 = $ ___________

Dues:
___ Individual $10
___ Family $15
___ Individual Life Membership $100

Total enclosed: $________

Please send this form with your check (made out to NCPHS) by October 5th to Mr. Earl Fitzgerald, 2213 Foxhorn Road, Trent Woods, NC 28562.