REGISTRATION

MEMBERS $50.00 NON MEMBERS $75.00

NAME___________________________________________

ADDRESS________________________________________

CITY___________________STATE____ZIP____________

Checks to: By Word of Mouth Storytelling

Mail to:
By Word of Mouth Storytelling
Truman H. Coggswell Sr.
P.O. Box 56
Frankford, MO 63441
573/784-2589    FAX: 573/784-2364 gladcogg@nemonet.com