CEA Convention 2019 Delegate Registration Form
Annual Convention of the Connecticut Elks Association
Email address *
Please fill out this form completely before submitting. You cannot edit the data after you have submitted your form - please email John Mancini if you need to make changes after submission. Note that the PER page comes at the end.
Please indicate your lodge. *
District *
Membership as of March 31, 2019 *
Your answer
Name and title of person submitting this form. *
Your answer
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