FLC Far West & Mid-Continent Regional Meeting
August 29-31, 2017 * Sheraton Pasadena Hotel, Pasadena, CA
Meeting Registration Form
1. ATTENDEE INFORMATION (Please fill in ALL information)ñPre ñFirst Name / ñLast Name / ñBadge Name- optional
ñAffiliation / ñPosition/Title
ñBusiness Address / ñ City / ñState/Province / ñZip Code / ñCountry
ñBusiness Telephone / ñBusiness Fax / ñEmail Address
I. 2. REGISTRATION FEES
Meeting Registration Options / Early Bird
on or before 8/18/17 / Regular
After 8/18/17 / Total Fees
Optional AMA Fundamentals of Marketing
Training Seminar, Tue 8/29 requires additional
fee and Full Meeting tuition (limited to 20 people) / $65.00 / $65.00 / $______
Full Meeting Tuition (Wed – Thu) Includes all Wed 8/30 activities, cont. breakfast, lunch, and awards banquet, Thurs 8/31 cont. breakfast and sessions / $250.00 / $295.00 / $______
Guest Wednesday Awards Banquet / $50.00 ea / $50.00 ea / $______
Optional Tour of NASA JPL (Limited to 20) / $20.00 / $20.00 / $______
Grand Total / $______
Special Requests:
q Vegetarian Meal | q I require special assistance. Please contact me.
3. METHOD OF PAYMENT
q American Express / q Visa/MasterCard / q Check
Name on Card: / Billing Address:
Card # / Expiration Date: ____ /____ CVV Code: ______
Amount $ / Date:
Signature:
Your signature authorizes your credit card to be charged the total payment above. The FLC reserves the right to charge the correct amount if different from above.
PLEASE FAX to: 856-667-8009 or call 856-667-7419 with any fax/form questions.
For meeting related questions, call Rick Shindell 360-681-4123
Payment/Registration Options:
Credit Card Option: If you are not comfortable with faxing your credit card information, you can select your Method of Payment on the form, and write in "Will Call". Then you can phone in your credit card information. To phone in, please call Jenna Mancuso, (from UTRS) at 856-667-7419 (9:00a to 4:00p est time).
Pay by Check Option: To register and pay by check, select the "Check" box in the Method of Payment section of the form. Please fax the registration form to 856-667-8009. Early Bird registration discount is based on faxing in your form on or before 8/18/17. The check should be made out and sent to:
Total Technology Behalf of the FLC/FW
(Please put FW/MC Meeting in the memo)
Send check to:
Jenna Mancuso
950 N Kings Hwy, Suite 208
Cherry Hill, NJ 08034
No Fax Option: If you are unable to fax your registration, you can phone it in to Jenna Mancuso, 856-667-7419 (9:00a to 4:00p est time).
We apologize for this inconvenience but due to new security standards, our host agency requires us to do it in this manner.
HOTEL: The meeting will take place at the Sheraton Pasadena Hotel, 303 Cordova Street, Pasadena, CA, 91101 . We have arranged for a block of rooms at the federal government per diem rate of $158.00 plus applicable taxes. This special rate is only available until August 8, 2017 or until sold out, whichever comes first, so book early.
You can book your room on line at https://www.starwoodmeeting.com/Book/FLC17 or by phone at (626) 449-4000. If the above link does not work, copy and paste it into your browser.
For more information please contact:
Far West - Rick Shindell - (360) 681-4123
Mid-Continent - Ann Kerksieck - (870)-241-3382