2005 KANSAS ASA STATE
AWARDS BANQUET BANQUET RESERVATION FORM
RESERVATIONS: $25 EACH

(PLEASE PRINT)

Name: _____________________________________________________________________________

Address: ___________________________________________________________________________

City / State / Zip: ____________________________________________________________________

Phone Number: _____________________________________________________________________

Number of Reservations:___________________________ Amount Enclosed:___________________

For confirmation of your banquet reservations call 785-622-4241. Deadline for banquet tickets is Wednesday, March 16, 2005.

Print Form and send completed form and amount due to: KASA Awards Banquet, HC 63 Box 111, Edmond KS 67646.

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