|
Constitution Party
of Pennsylvania
|
|
1998 State Convention Reservation Form
|
|
|
|
|
|
|
Yes,
I would like to make RESERVATIONS for the
HISTORY MAKING Constitution Party of Pennsylvania
1998 STATE CONVENTION.
Name (First - Middle Initial - Last)
County of Residence
Address
City
State
Zip
Home Phone
Work Phone
Fax
Email Address
Occupation
Employer Name
Business or Work Address
City
State
Zip
|
|
|
|
|
|
|
Constitution Party
Membership
|
|
( check ONLY one )
|
|
|
|
I
am a Constitution Party of Pennsylvania member.
|
|
|
|
I
am NOT a Constitution Party of Pennsylvania member.
|
|
|
|
I
am a Constitution Party of Pennsylvania dues-paying Affiliate.
|
|
|
|
|
|
|
|
Convention
Attendance
|
|
( check ONLY one )
|
|
|
|
I
will attend. Payment enclosed for option(s) selected below.
|
|
|
|
I
CANNOT attend but support the Constitution Party by
enclosed contribution.
|
|
|
|
I
am attending as a GUEST. **
|
** GUESTS are non-voting attendees who are welcome to observe,
but may not participate in, Party business.
|
|
|
|
|
|
|
|
Attendance
Options
|
|
( Amounts Include Gratuity and PA Sales Tax, If Applicable )
|
|
( Check All that are Applicable )
|
|
|
|
OPTION
A: - Registration fee, Saturday Luncheon,
both Saturday sessions.
$60.00 Select ONE Luncheon entree:
Chicken
Beef
Julienne Salad
|
|
|
|
OR
|
|
|
|
OPTION
B: - Option A - PLUS - Friday and Saturday
Dinners. $85.00 Select ONE Dinner entree EACH Day:
FRIDAY
Chicken
Beef
Pasta
SATURDAY
Chicken
Beef
Pasta
|
|
|
|
EXECUTIVE
COMMITTEE MEMBER enclosing additional $10.00 for
Saturday Breakfast.
|
|
|
|
Yes,
I would like to give a GENERAL CONTRIBUTION to the
Constitutional Party of Pennsylvania.
|
|
|
|
What amount would you like to contribute to the Constitution Party of
Pennsylvania?
We are NOT one of the two Rich Major Political Parties.
Please be as GENEROUS as possible!
Amount: $
|
|
|
Individuals, from any where in the USA, may contribute up to $5000.00
from their personal funds!
|
|
|
|
Corporate gifts are prohibited.
|
|
|
|
Contributions are NOT tax deductible and may be used to Advance the
Principle's of the Constitution Party of Pennsylvania.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Payment Information
|
|
|
|
I
would like to Pay by PRINTING this COMPLETED FORM and
MAILING it with my CHECK To:
|
|
|
|
|
|
|
Constitution Party of Pennsylvania
|
|
P.O. Box 1766
|
|
Lancaster, PA 17608-1766
|
|
|
|
I
would like to Pay "Securely" by Credit Card
|
|
|
   
|
|
|
|
Credit Card Options:
Express
|
|
|
|
Name as it appears on your Credit Card:
|
|
|
|
Account Number (Do not use spaces or dashes):
|
|
|
|
Expiration Date (Do not use spaces or dashes):
|
|
|
|
Note: For your Internet Security protection, this transaction
is being sent
through a "Secured" [SSL] server.
|
|
|
|
For maximum Internet Security protection, your only receipt, besides
your normal monthly credit card statement, will be a "Thank You"
!
|
|
|
If necessary, an official date/time-stamped receipt can be requested
by
Email: Webmaster@Constitutional.Net
|
|
|
|
Press to your RESERVATION or to start over.
|
|
|
Thanks for Contributing to the Constitution Party of Pennsylvania!
|
|
|
|
|
|
|
|
|
|
Mail contributions or request more information:
|
|
Constitution Party
of Pennsylvania
|
|
PO. Box 1766 Lancaster, PA 17608-1766
|
|
717-299-6285
|
|
Email: Jesse
C. Wagner II
|
|
|
|
Paid for by the Constitution
Party of Pennsylvania
|
|
James Clymer, Treasurer
|
|
|
|
|
|
|
|
HOME PAGE
1998 STATE CONVENTION
|
|
|
|
|
|
  The
author is a member of 
|
|
|
|
|
![[Aaddzz AD INFO]](http://ad1.aaddzz.com/logo.cgi?id=8) ![[Aaddzz Advertisement]](http://ad1.aaddzz.com/image/1/3328/www.Constitutional.Net/convention_reservations1998.html) ![[Aaddzz Advertisement]](http://ad1.aaddzz.com/image/2/3328/www.Constitutional.Net/convention_reservations1998.html)
![[Aaddzz Advertisement]](http://ad1.aaddzz.com/image/3/3328/www.Constitutional.Net/convention_reservations1998.html)
|
|
|
|
|
|
|