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 Please Mail this completed and signed form to:

Rev. Daniel J. Teller
Secretary of the NID
Our Redeemer Lutheran Church
304 W. Palatine Road
Prospect Heights, IL  60070-1199

 QUESTIONS ????

 Phone: 847-537-4430

Email: Teller4DS@aol.com

All Delegate Forms must be received by February 17, 2006
to appear in the Convention Workbook