2010 Tri-State Convention Registration

2010 PAMIC/VAMIC/WVAIC Tri-State Convention Registration
August 8 – 10, 2010
The Greenbrier • White Sulphur Springs, WV


Registration deadline is July 29, 2010. Registration Fee includes Welcome Reception, Continental Breakfasts, Luncheon on Monday, Refreshment Breaks, Chairman’s Reception, Convention Registration Materials and all Convention sessions. Not included in Registration Fee: Larry Kauffman Interfaith Breakfast ($35).

Name
Badge Name
Company
Address
City	State ZIP Code
Phone
Email
Please describe any Dietary or Accessibility Needs, if applicable:
registration fees
PAMIC/VAMIC/WVAIC Member Registration Fee (before July 15): $295 PAMIC/VAMIC/WVAIC Member Registration Fee (after July 15): $350 Non-Member : $395 Spouse : $195 Child Over 12 : $50 Child Over 12 participating in Children’s Program : $80 Child under 12 : $25 Child under 12 participating in Children’s Program : $65 I would like to attend the Larry Kauffman Interfaith Breakfast. (add $35) Number Attending the Breakfast: I would like to attend the Family Volleyball Tournament. Please Indicate Amount & Sizes of Complimentary T-Shirts Required (S, M, L, XL or XXL): I plan to attend the Welcome Reception. I plan to attend the Chairman's Reception & Banquet. My spouse will be attending the Spouse's Program. I want to register for the Golf Tournament on August 10th. (Fill out info below.)
Spouse Name	Volleyball Tournament?
Spouse Email
Child 1 Name & Age	Volleyball Tournament?
Child 2 Name & Age	Volleyball Tournament?
Child 3 Name & Age	Volleyball Tournament?
Child 4 Name & Age	Volleyball Tournament?

Golf Tournament Registration
I will SPONSOR the foursome listed below: $660
Names in Foursome
Company
Email


I will be PLAYING in a foursome with the golfers listed below: $165
Other Players' Names


I will be playing. Please PUT ME IN A FOURSOME: $165 I would like to be a HOLE SPONSOR: $150 I will CONTRIBUTE as a prize.

registration total $

I will be sending a check to pay for my registration. I will pay online using Paypal.* Please send an invoice. * Please note that a $5 service fee will be charged for using this service.

Cancellation Policy: A refund will be given if notice of cancellation is received on or before July 29. Cancellation received after this date will not be eligible for a refund. Please note a $25 processing fee will be charged for each refund issued.