The AHEPAN - March 2011 - (Page 10)
reGiStration
delegate/alternate or Guest registration
pleaSe uSe one Form per perSon
Name _________________________________________________ Chapter No. ______________ District No. ______________ Address ___________________________________________________________________________________________________ City ___________________________________________________ State __________________ Zip Code __________________ Phone (____) _________________________ Fax (____) __________________________ Email __________________________
For Which organization are you registering?
Please check one on each line. AHEPA Daughters of Penelope Sons of Pericles Maids of Athena Guest I Am Registering: Guest Delegate Alternate Membership No. (required) ____________________________
Fees
ahepa delegate/alternate $225 $ ______________ (Includes: Welcome Night, Greek Glendi, Grand Ball, Grand Banquet and Athletic Luncheon) dop delegate/alternate $225 $ ______________ (Includes: Welcome Night, Greek Glendi, Grand Ball, Grand Banquet and Athletic Luncheon) non-delegate/Guest $275 $ ______________ (Includes: Welcome Night, Greek Glendi, Grand Ball, Grand Banquet and Athletic Luncheon) All Delegates/Alternates MUST provide proof of occupancy at the Fontainebleau Hotel or be subject to $100 registration surcharge (4 Night minimum stay). Dade & Broward county residents are excluded.
total: $ ______________ checks payable to:
AHEPA Supreme Convention Fees MUST accompany this form I have enclosed Check No. ____________ in the amount of $ ____________ Charge my: VISA Master Card AMEX
mail to:
AHEPA 1909 Q Street, NW Suite 500 Washington, DC 20009
Card No. _____________________________________ Exp. Date ____________ Signature ____________________________________________________ _______________
deadline
Form and fees MUST be postmarked, faxed, or emailed by Thursday, June 30, 2011
refund policy
Refund requests MUST be received in writing by Friday, July 1, 2011. If received by this date, a refund will be issued, less a $35 administrative fee.
no refunds will be issued after July 1, 2011!
Pre-register and Win Free Dinner in Miami!
www.ahepa.org
http://www.ahepa.org
http://www.ahepa.org
Table of Contents for the Digital Edition of The AHEPAN - March 2011
The AHEPAN - March 2011
Contents
Supreme President’s Message
AHEPA Family News
The Periclean
Meet Us in Miami!
2011 AHEPA Convention Registration Form
Housing
AHEPA Family Chapter News
The AHEPAN - March 2011
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