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
Your answer
Last Name *
Your answer
Additional adult attendees Full Names
(Please create new registrations for those with a different address)
Your answer
Street Address *
Your answer
City *
Your answer
State *
Two-letter abbreviation IA, IL, WI, MN, NE, MO, SD
Your answer
ZIP Code *
Your answer
E-mail address *
Your answer
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
Pork
Chicken
Vegetarian
None
Would you like to assist with our Culture of Life Dinner?
Please ask any questions you have or leave comments here!
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Please leave suggestions on how to improve this registration form; our dinner; and our program!
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