Historical Harp Society Conference  -  July 15-17,  2005

Name:

Address:

Phone:

E-mail:

Circle as Appropriate Below:

□          Conference Attendance, Saturday Only                           $50

□          Conference Attendance, Sunday Only                             $20

□          Conference Attendance, Entire Conference                     $70

□          Send Housing Form for Conference                                -----

□          Renew or Extend Membership                                        $25

□         Gift/Contribution                                                        $_____

TOTAL                                                                              $______

Please send this form with a check payable to Historical Harp Society:

mail to Jean Humphrey, 631 North 3^rd Avenue, St. Charles, IL, 60174

as early as possible, and before July 8, 2005.

Questions: or Jean or Anne  Humphrey at 630-584-5259.

(use your browser File/Print menu option to print this page,
then fill it out and mail it to the registrar with appropriate payment.)