75th Annual Southeast Division Conference Registration Form
Baton Rouge LA – March 18th thru 21st, 2021
NAME:_______________________________________________________________________
PREFERRED NAME (for Name Tag): _________________________________________________
MAILING ADDRESS: ______________________________________________________________
CITY: ____________________ STATE: _____ ZIP CODE: ________ PHONE: _______________
EMAIL*:_________________________________________________________________________
MCL Detachment Name: ________________________________________ Number: _____
GUEST(S): ______________________________________________________________________
PREFERRED NAME(S) (for Name Tag(s)): _________________________________________________
BANQUET – Saturday March 20, 2021 ($54.00 per person)
Plated Dinner includes Tossed Garden Salad or Caesar Salad, Dessert, Dinner Rolls, Iced Tea and Coffee
CHICKEN FLORENTINE Number: ____
Chicken Breast stuffed with Spinach and Feta topped with a Provençale Sauce,
Wild Rice and Haricot Verte
FILET OF BEEF Number: ____
8 oz. Filet of Beef with a Port Wine Demi-Glace, Garlic Mashed Potatoes
and Asparagus
Special meal requests email Dick Brandt at dbcon@hotmail.com
Mail this registration form and payment Check # ___________
(Make Checks payable to “Choctaw Detachment # 778”) to: Date: ____________
Choctaw Detachment # 778
SED Conference
11528 Old Hammond Hwy Apt 1904
Baton Rouge LA 70816-8441
*We will confirm receipt of your registration via e-mail
Any questions please call/text Dick Brandt at (225)252-0923 or email at dbcon@hotmail.com
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