Starved Rock Weave
June 11, 2002
Registration and Order Form
Order kits by May 15, 2002
Name: _________________________________________________________
Address: ________________________________________________________
City, State, Zip: __________________________________________________
Phone Number: __________________________________________________
Email: __________________________________________________________
| Item: | Quantity: | Price: | Total: |
| Registration | ___________ | $20.00 | ___________ |
| Small Star Kit | ___________ | $15.00 | ___________ |
| Large Star Kit | ___________ | $20.00 | ___________ |
| Small Star - Base Only | ___________ | $5.00 | ___________ |
| Large Star - Base Only | ___________ | $5.60 | ___________ |
| GRAND TOTAL: | ___________ | ||
Make check for above amount payable to: Land of Lincoln Basket Weavers Assoc.
Mail to: Janelle Kehl, 113 Calvert, Chadwick, IL 61014