2027 DSA NON-REPRESETATIVE FORM | Dixie Shrine Assoc 1

2027 DSA
NON-Representative Registration Form
Complete One Only One Time Please is you need to edit your submission contact
_____________ at (999)999-9999

Temple

Noble / Registrant Name

Lady / Guest Name

Registration Qty

$20 per person. Enter the total number of people registering, including yourself and any guests.

President Banquet Qty

OPTIONAL — $30 per person. Enter the number of President's Banquet tickets requested. Enter 0 or leave blank if not attending.

Ladies Luncheon Qty

OPTIONAL — $30 per person. Enter the number of Ladies' Luncheon tickets requested. Enter 0 or leave blank if not attending.

Office Held

Notes

Phone

REGISTRATION FEES & PAYMENT INFORMATION

Registration: $20 per person

President's Banquet (Optional): $30 per person

Ladies' Luncheon (Optional): $30 per person

No payment will be collected through this form. A confirmation email with your registration details, itemized charges, and total amount due will be provided after submission, once the confirmation system is activated.

2027 DSA NON-Representative Registration Form Complete One Only One Time Please is you need to edit your submission contact _____________ at (999)999-9999

2027 DSA
NON-Representative Registration Form
Complete One Only One Time Please is you need to edit your submission contact
_____________ at (999)999-9999