SOUTH ATLANTIC SHRINE ASSOCIATION

SEPTEMBER 19, 20, 21, 22, 2012

PLEASE READ ALL INSTRUCTIONS VERY CAREFULLY

Potentate, Dave Juergens is looking forward to a great convention in Myrtle Beach, South Carolina for all members of Kosair Shrine. He has reserved rooms at the Compass Cove Resort; 7100 N Ocean Blvd; Myrtle Beach, South Carolina. If you want to make your own reservation please call 843-448-8373 ext 0 under Kosair Shrine Block. You will still owe $10.00 registration to the Shrine Office.

In order for the Shrine Office to make your reservations, this application must be returned with payment no later than August 13, 2012. Each noble is required to pay a $122.26 or 126.78room deposit, in advance, and all registration fees. Each individual will pay the hotel direct for the balance of nights staying when you check out. This will be your responsibility not Kosair Shiners’

Please review your application carefully and make sure everything is correct before turning it into the Shrine Office. If you have any questions, please feel free to call the Shrine Office.

Reservation form must be turned into the Shrine Office on or before August 13th. After August 3rd, there will be no cancellations. Deposit will be forfeited unless there is a person on the waiting list to take your place.

(Cut along doted line)

………………………………………………………………………………………………………………………….

THE DIVAN AND UNITS OF KOSAIR SHRINE WILL BE HOUSED AT THE “COMPASS COVE RESORT; 7100 N OCEAN BLVD; MYRTLE BEACH, COUTH CAROLINA. YOU CAN CALL 843-448-8373 EXT 0 TO BOOK YOUR OWN RESERVATION, BUT DON’T FORGET TO PAY $10.00 REGISTRATION FEE TO THE SHRINE OFFICE.

NAME______PHONE______

YOUR UNIT______

ADDRESS______CITY______ST______ZIP______

If your wife will be attending list her first name______or name of roommate______

___ Check here if you are attending the convention, but will not need a hotel room. Charge for this is $10.00 per noble.

Make check payable to: KOSAIR SHRINERS or

Visa #______MasterCard#______

Discover ______Expiration Date______Card Holders Name______

Payment (one night room deposit and $10.00 registration) must accompany application. Balance will be paid to the hotel direct, by you, when checking out. This will not be Kosair Shrine’s responsibility. Rates DO NOT include transportation.

COST—ONE NIGHT ROOM $122.26 OR $126.78

REGISTRATION FEE $10.00 10.00

TOTAL DUE KOSAIR TEMPLE$132.27$136.78

(BALANCE DUE TO HOTEL UPON DEPARTURE)

I HAVE READ AND UNDERSTAND ALL THE ABOVE INFORMATION AND INSTRUCTIONS.

______

signature

Send form to SASA c/o Kosair Shriners, 812 South Second Street, Louisville, KY 40203 NO LATER THAN AUGUST 6th.

DAVE JUERGENS Potentate

EDDIE CHRISMAN, PP, Recorder

Any noble wishing to arrive early or stay later must let the Office know when turning in their application. One night room deposit must be made payable to Kosair Shrine. You must pay the balance direct to hotel upon arrival.

Arrival date ______Departure Date______