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Upcoming Events

Jan 13-14, 2012 - REGIONAL OUTREACH CONFERENCE - Orlando, FL

March 6-11, 2012 - North Dakota Winter Show - NDLLL Booth

March 24, 2012 - District Officers Mtg - 10am @ Jamestown

June 16, 2012 - District Officers Mtg - 10am @ Jamestown

Oct 26-27, 2012 - NDLLL District Convention - Immanuel Lutheran - Wahpeton, ND



This is a generic registration form for North Dakota LLL Events.
You may submit your form electronically but we also recommend that you print it out and bring it in.

If you are under 18, this form MUST be signed at the bottom by a parent or legal guardian.
YOUR REGISTRATION IS NOT FINAL UNTIL YOU HAVE PAID THE DEPOSIT FOR THIS EVENT.

Event Date(s):
Full Name:
Street Address:
City, State Zip:
Birthdate:
Email:
Parent Names:
Parental Numbers:
Secondary Contact:
Secondary Numbers:
Insurance Company:
Ins. Phone Number:
Policy Number:
Allergies:
Medications:
Additional Info:
Enter 777 here:
Permission Signature of Parent/Guardian:

___________________________________________________



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