(Printable Form)
The Evansville Chapter of the
AMERICAN GUILD OF ORGANISTS
is pleased to announce
PEDALS, PIPES, AND PIZZA
MONDAY, FEBRUARY 21, 2005
(PRESIDENTS’ DAY)
THEN PLAN TO ATTEND PEDALS, PIPES, AND PIZZA 2005!

LOCATION: Aldersgate United Methodist Church, 5130 Lincoln, Evansville 47715

REGISTRATION FEE: $10.00 which includes all materials plus lunch.
REGISTRATION DEADLINE: Friday, February 18, 2005.
QUESTIONS? Please contact Helen S. Reed, 812-476-0673, hsr@evansville.net.
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YES, sign me up for PEDALS, PIPES, AND PIZZA , FEBRUARY 21, 2005!
Please print out and complete this form, and mail it by February 18, 2005 to:
Helen S. Reed, Education Convener, 1435 Brookside Dr., Evansville IN 47714
Please enclose a check or money order for $10, payable to Evansville Chapter A.G.O.

Name: _______________________________________________________________________

Address: _____________________________________________________________________

City: __________________________ State/Zip: ________________Phone: ______________

Date of Birth: _______________ School: _____________________________ Grade: ______

I have taken piano lessons for ___________ years.

I have special dietary requirements: ________________________________________________

This student (under age 18) participates in PEDALS, PIPES, AND PIZZA with my permission.

Signature of Parent or Guardian:___________________________________________________