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Pioneer Program Registration Form Oak Brook Park District


www.obparks.org | (630) 645-9590 | registration@obparks.org Autumn 2016 Registration | Separate households require separate forms.


Part 1 Household Information


Names _____________________________________________________________________Birthdate (required):_______________________________ Address_____________________________________________________________________________________________________________________ City_________________________________________State____________________________Zip Code______________________________________


Phone_______________________________________Email Address__________________________________________________________________ (to receive email confirmations)


**Please indicate if a registrant has any dietary needs or requires any special accommodation or assistance for enjoyment of programs. Any request needs to be made at registration. _____________________________________ ____________________________________________________________________________________________________


Part 2 Program Registration Code


(please circle) 6189 6188


6537 6075 6540


6539


6538 6579 6554


6190 6191 6192 Activity Brain Games Rules Of the Road


This Trip is for the Early Birds White Sox Vs Cleveland Indians Open House Chicago


Deutschland in Chicago Choose:


Weiner Schnitzel Sauerbraten


Singin’ in the Rain at Marriott Lincolnshire


KIng Charles III Salute to Vienna


Choose: Prime Rib Salmon


Afternoon Movie Matinee My Old Lady


Afternoon Movie Matinee Second Best Marigold Hotel


Afternoon Movie Matinee Gotta Dance


Form continues on the back 11/2


11/13 12/31


9/29 10/27 11/22


$108/$114 Depart: Tennis Center Parking Lot. $135/$141 Depart: Tennis Center Parking Lot. $143/$149 Depart: Tennis Center Parking Lot.


FREE FREE FREE Canterberry Room Canterberry Room Canterberry Room Total Fees Paid Date


11/7, 11/14, 11/21 11/18


9/7 9/15 10/15 10/26


R/NR Fee


FREE FREE


$59/$65 $80/$86


Location


Canterberry Room Canterberry Room


Depart: Tennis Center Parking Lot. Depart: Tennis Center Parking Lot.


$64/$70 Depart: Tennis Center Parking Lot. $80$86 Depart: Tennis Center Parking Lot.


Fees Paid


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