This Is a Dinner for Friendship, Fellowship and to Recognize Volunteers for Exceptional

2017 IROQUOIS/SHAWNEE DISTRICT RECOGNITION DINNER

Saturday, January 14th, 2017 6:30 – 8:30pm This is a dinner for friendship, fellowship and to recognize volunteers for exceptional service in 2016.

Cost: $15.00 if paid on or before January 6, 2017; after January 6, 2017 including at the door $20.00. All foreign cars must park in the side lot to the right of the building.

Contact John R. Benz at 502-905-3202 or at [email protected] or George Sloan at 502-400-5375 or [email protected] for more information.

Please submit all Award forms to John Benz no later than December Roundtables ------Cut along dotted line

Unit Type and #:______DISTRICT: ______NAME: ______MAILING ADDRESS: ______CITY: ______ST: _____ZIP: ______PHONE: ______EMAIL:______Before January 6, 2017 - $15.00 x = $ Paying at the door - $20.00 x ____ = $______METHOD OF PAYMENT: ______(Credit Card, Check, Cash) Name on Credit Card: ______Billing Address: ______City: ______State:______Zip:______Amount to be Charged: ______

Credit Card Number: ______Card Expiration Date: ______1-6801-005-20 CVC (Code on back of card): ______Mail this in: Fax this in: Lincoln Heritage Council 502-361-7899 Attn: Iroquois Recognition Email this to: Dinner George.sloan@scouting. 12001 Sycamore Station org

1-6801-005-20