Silver Clover/Gold Star- Reservation Form

The area Electric Co-ops that serve the counties in our district will provide meals for: • Honoree and their Spouse (OR alternate guest) • Agent
County:*
Please list the names of ONLY those that will be ATTENDING the banquet:
Gold Star Honoree:
Gold Star Parents:
Gold Star Honoree:
Gold Star Parents:
Silver Clover Honoree:
Silver Clover Spouse:
Silver Clover Honoree:
Silver Clover Spouse:
Additional Guests (County Check Due - $30 each)
Additional Guests (County Check Due - $30 each)
Additional Guests (County Check Due - $30 each)
Additional Guests (County Check Due - $30 each)
Extension Agent:
Agent Spouse
Extension Agent
Agent Spouse
District Council Officer
Officer Parents

The area Electric Co-ops that serve the counties in our district will provide meals for: • Honoree and their Spouse (OR alternate guest) • Agent