
About this Event

REGISTRATION FORM
Name: ______________________________________________
Address: ____________________________________________
City: _____________________ State: _______ Zip: _________
Affiliation: ___________________________________________
Email: ______________________________________________
Check Enclosed? Yes _____ No _____
Send Invoice? Yes _____ No _____
Make Checks Payable to:
Mail check and registration to:
Michelle Anderson
7601 Holliday Drive
Kansas City, KS 66106
To pay by credit card: register and pay online at kleaks.org, mail form, or contact Michelle Anderson at (913) 291-8783
Event Venue & Nearby Stays
Fiorella's Event Space, 9000 West 137th Street, Overland Park, United States