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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