Please type or print clearly

Name ___________________________________________________________________________________

Address _________________________________________________________________________________

City, State, Zip ____________________________________________________________________________

Phone (    ) ____________________________________ Email _____________________________________

LLBWA Member _____Yes _____No      

I am attending as (check all that apply) __student  __vendor __ teacher 

Is this the first time you have attended the LLBWA Camp Tuck event?  ____Yes _____No

Registration forms postmarked through June 1, 2009 will be treated as first day registration.  Postmarks after June 1 will be accepted according to post mark date and class assignments will be subject to available space in the class.  Please mail your registration as soon as possible.  The registration fee does not include class material fees which will be due upon notification of your class assignments.

In the spaces below, list the class choices in the order of preference.  Please do not list any classes you are not willing to take.

I have enclosed the registration fee of $45 one day or $70 for two days made payable to LLBWA

I would like to volunteer to help as needed

I have enclosed a self-addressed, stamped envelope

 would like to donate a Door Prize item

I would like to donate a gift bag item

I plan to enter in the People’s choice contest

Please send this form, a check for the registration fee made payable to LLBWA, and a self-addressed stamped business size envelope to:

Mary McKinzie

401 Victoria Drive

Washington, IL  61571