Libertarian Party of Colorado Convention 2003
Registration Form
Please print out this form and send with payment, payable to "Carol Geltemeyer," to
Nancy Graves
3724 E. LaSalle St. #1310
Colorado Springs, CO 80909
Nancy may be reached 719.570.0747, or 719.310.9444, or by e-mail at lpco2003@pcisys.net.
____Full Convention (Option #1): $129
____Full Convention, except banquet (Option #2): $99
____Banquet Only (Option #3): $49
____Full-Time Student: $49
Payment form: Check____ Money Order____
Visa____ Master Card____ Acct. #___________________ Exp._____
Signature (for credit card): ____________________________
Name(s) _____________________________
Address ___________________________________
City __________ State ____ Zip __________
Phone ______________ E-mail ___________________
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