NH Queens' Council Registration Form

This form, plus check payable to: Linda Duquette 

for $24  per crown/person to reserve your place at the

Sunday, May 20, 2012

Send to:  Linda Duquette

33 Drew Rd

Derry NH 03038

Your Chapter Name :

_____________________________________________

Contact information:

Queen's Name/Title: _______________________________

Phone:  Home: _______________________

  Cell: _________________________

Email:____________________________________

Snail Mail: (otherwise known as reality, street address or PO Box)_____________________________________

_____________________________________

Vice Queen's Name/Title: (for instance, if you have a princess or a co-queen instead of a Vice Queen)______________________________________

Phone:Home:  ________________________

Cell: __________________________

Email: _________________________________

Snail Mail: _____________________________

______________________________________

If Delegates are attending in lieu of Q/VQs, please supply the

above information AS WELL AS the contact information for each delegate.

Delegates:  ONLY if Queen, Co-Queen, or Vice Queen unable to attend, you may send up to two delegates from your chapter.

Name and Title/nickname, if any for 1st delegate: ________________________________________

Phones: Home____________________________

Cell_____________________________

Addresses:  home___________________________

_____________________________________

Email:_____________________________________

Name and Title/nickname, if any for 2nd delegate:

__________________________________________

Phones:  Home_______________________________

Cell________________________________

Addresses: home______________________________

__________________________________________

Email:_____________________________________

I am a Pink Hatter _______ 

I have a birthday in May _____

This is my first Queen’s Council gathering _______

Make check payable to: Linda Duquette

Mail registration form and check to:

Linda Duquette

33 Drew Rd

Derry NH 03038

Deadline:  May 12, 2012

Again, please note it is best to copy the form, as much as you need, paste to a word doc or whatever you use, and then fill it in.  -- truly it is best way..

Your Web Queen, Katella

Click here to return to luncheon details

Spring Gathering Sunday, May 20, 2012

at the Atkinson Country Club  It will be a buffet so no menu choices needed. Please register by May 12, 2012.