Please print and fill out this form and then mail with your check made out to Lincoln County CASA.

______ $35 per person

______ $60 per couple

Name: _________________________________________________________________

Address:________________________________________________________________

_______________________________________________________________________

Phone: _________________________________________________________________

Organization or club (if applicable):___________________________________________

Do you want a table of eight ($240) reserved for your organization or club?

______ Yes

______No
PLEASE MAIL TO:
Lincoln County CASA
P.O. Box 707
Newport, Oregon 97365

For information or questions, e-mail lccasa@newportnet.com
or call 541-265-3116

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