2012 OIW ASSEMBLY REGISTRATION FORM

PRINT OUT REGISTRATION FORM & MAIL IT TO:

OIW, PO BOX 1650, JOHNSTOWN, COLORADO 80534

I am a current OIW member with dues paid (circle one):	YES    NO
I am paying my 2012 dues of $30.00/year now (or $45.00 for a family membership)	$
I am paying a deposit of $TBD for the following:
Current OIW Member	$
Spouse of OIW Member	$
- Add $15 if spouse is not a current OIW member	$
Friend of OIW Member	$
- Add $30 if friend is not a current OIW member	$
I am paying the following fees in full:
Current OIW Member -- Assembly fee of $TBD per person	$
Spouse of OIW Member -- Fee of $TBD	$
- Add $15 if spouse is not a current OIW member	$
Friend of OIW Member -- Fee of $TBD	$
- Add $30 if friend is not a current OIW member	$
Full payment is due by TBD
Total enclosed with registration (plus dues if applicable)	$

NO REFUNDS AFTER TBD!

Name(s) _____________________________________ & _______________________________________

Address _____________________________________

City, State, Zip _______________________________

Phone _______________________________________

Email Address ________________________________

Please send check or money order to:

OIW 2012 Assembly, P.O. Box 1650, Johnstown, CO 80534

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