Candidate Information Form

District of Georgia, Desoto Province

CANDIDATE INFORMATION FORM

Fields marked (*) are required

Candidate Name:*

Address: City: State: Zip code:

Phone Number: Email Address: Council Number:

Will you attend the men's luncheon? The cost is $20.00: Yes/No

Will you stay for the banquet?: Yes/No

Will your wife or girlfriend be attending the ladies luncheon? The cost is $25.00: Yes/No

Spouse's Name:

Will your wife or girlfriend be attending the banquet? The cost is $45.00: Yes/No

How many additional tickets besides your own at $45.00 each will you need for the banquet? (wife, girlfriend, children ,parents, etc.):

All checks should be submitted to your Assembly.

Names of Attendees:

Please print this form before submitting it.

Please remember that the dress code for the exemplification is plain black tux, plain whiteshirt (no wing collars or ruffles), black cummerbund or vest, black bow tie, black hose and ,black shoes.