16^th Annual Convention Registration Form

July 16 – 17, 2010

Company Name:  

Mailing Address:  

City:   State:   Zip:  

 Phone:   Email:  

                        Convention Registration Fee:               $ 195 per person  x  0 1 2 3 4 5 6 people = $

Name of Registrant:   Guest/Spouse Name:

Name of Registrant: Guest/Spouse Name:

Name of Registrant: Guest/Spouse Name:

                                + Golf Tournament:                              $ 145 per person x  0 1 2 3 4 people = $

Golfer: Score:    Golfer: Score:

Golfer: Score:    Golfer: Score:

                                 + Fishing Tournament:                                               $ 145 per person x  0 1 2 3 4 people = $

Fisherman:   Fisherman:

Fisherman:   Fisherman:

          + Kids Program: (separate registration form required)                  $ 65 for 1st child; $ 35 for 2nd from same sleeping room x  0 1 2 3 4 children =  $

Child’s Name: Age: Child’s Name: Age:

Child’s Name: Age: Child’s Name: Age:

                                + Banquet (Saturday)                                                  $ 135 per person x   0 1 2 3 4 people =  $

Attendee: Attendee:

Attendee: Attendee:

Total:  $  

Yes, Let’s have another Associates vs Producers volleyball game.

Yes, will attend “Concretians” – the Ladies of FICAP meeting on Saturday morning.

     Additional attendees:

• Your completed registration form should indicate what activities you are choosing. Your payment must include the Convention registration fee, plus any activities you select for each person who will be attending.
• Early bird registrations (if received, including full payment, before June 1), you may deduct $ 30 from your total payment.

Method of Payment: Once you submit this page, you will have the option of paying on line, or mailing in a check.  Please select which method you plan on using: On Line    Mail a Check

Please make sure you enter in the correct pricing including the total, then press "Submit".