Club Membership Registration Form

2019 BLACK HISTORY MONTH AWARDEES
Complete THE NAME OF THE ACCEPTOR OF THE AWARD and submit.

Thank you!
Date

MonthDayYear
Date
Name

First NameLast Name
E-mail
Phone Number:

Area CodePhone Number
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
BLACK HISTORY MONTH CELEBRATION

SUNDAY, February 24, 2019

1037 W. McKinley Avenue

Milwaukee, WI

Arrival time: 2:30pm

Event time: 3-4:30pm

Dress Code - Business Casual

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Your guest can RSVP - Ticket Purchase of $35.00 - 1 person or $55.00 for 2.

Go to:

https://form.jotform.com/81548961538166

CLICK
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2019 BLACK HISTORY MONTH AWARDEES