Culture of Life Dinner Registration
Dinner and program to be held at St. Wenceslaus parish hall on Saturday, April 28th, 2018
First Name *
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Middle Initial
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Last Name *
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Additional adult attendees Full Names
(Please create new registrations for those with a different address)
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Street Address *
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City *
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State *
Two-letter abbreviation IA, IL, WI, MN, NE, MO, SD
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ZIP Code *
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E-mail address *
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Is child care needed?
Full name(s) and ages of those needing child care
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Special Facility Requirements
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Special Nutrition Requirements
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Meal Preference
Guest 1
Guest 2
Guest 3
Guest 4
Would you like to assist with our Culture of Life Dinner?
Please make suggestions on how to improve this form and our Culture of Life Dinner. Thank you for registering!
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