Legion of Valor Convention Registration Payment

Convention Registration Payment
Full Name*

First NameLast Name
Member/Guest

MemberGuest
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail
Phone Number*

Area CodePhone Number
If mailing registration, print this page. Mail to:

Victor Binkoski
126 Northrop Road
Bethany, CT 06524-3608
My Products
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Member, Spouse or Guest Registration (one)$125.00

Member, Spouse or Guest Registration (one)$125.00

Member, Spouse or Guest Registration (one)$125.00

Member, Spouse or Guest Registration (one)$125.00

Banquet Guest Only$100.00

Banquet Guest Quantity

Total $0.00
Should be Empty: