Annual Business Meeting and Luncheon - Registration

Please fill out the following information and send a printed copy with the donation of $10.00 NO LATER THAN Wednesday, June 17, 2009 to Evelyn Ortiz Smykla (Chair Latino Caucus), PO Box 122, Gulf Shores, AL 36547.

Make check or money order payable to Evelyn Ortiz Smykla. On the memo line indicate it is for the Latino Caucus Meeting/Luncheon.

Name: __________________________________________

Institution: __________________________________________

Address: __________________________________________

Total enclosed: ______________________________________________________________

E-mail address (for payment receipt): __________________________________________