Fall 2009 Institute On The Constitution Registration

Name:______________________________________________________________________

Address:____________________________________________________________________

City:__________________________________________ State:__________ Zip:__________

Phone:__________________________________________________ Ext:_______________

E-mail:_____________________________________________________________________

*Occupation:________________________________________________________________

*Employer: _________________________________________________________________

* Required only for contributions exceeding $50 per year
 

Please reserve ______ seats for the Fall 2009 IOTC at Gander Mountain in Harrisburg.

I understand the per session cost is $10 each and I have enclosed $_______.
 

Signature:____________________________________________________________________
 

I cannot attend the Fall 2009 IOTC but please accept the following contribution: $________*

Make checks payable to:
Constitutional Organization of Liberty
P.O. Box 822
Lebanon, PA  17042
717-228-7524

*Pennsylvania law requires that we report the name, address, occupation, and employer for each individual whose contributions
aggregate in excess of $50 in a calendar year.  Political contributions are not tax deductible.  No corporate checks can be received.
Federal limit per individual is $20,000 per year.

The Constitutional Organization Of Liberty reserves the right to reject any applicant for participation or membership or to
terminate same for due cause as determined by the Executive Committee with a full refund of dues for the respective calendar year
in which termination occurs.

Paid for by Constitutional Organization Of Liberty - Monica Carpenter, Treasurer