Page 53 - ESA IC News April

2018 IC Convention

Years of Service Ceremony

Name: __________________________________________________________________
Address: ________________________________________________________________

Email: ____________________________________ Phone Number: _________________

Number of years for Service Recognition (Please Circle)

25 30 35 40 45 50 55 60 65

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Over 65 years __________ (enter the number of years) ***

*** Those celebrating 60 years or more will be recognized at the Banquet Saturday Night.

Recipients must be in attendance at the
International Convention to be recognized.

Please do not bring or mail service pins.

Please return this form to:

Mary Humphrey, IC Corresponding Secretary
th
56295 E. 28 Ct., Strasburg, CO 80136
marykh@tds.net

Please return by June 15, 2018