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Air Care 2001

April 28, 2001, Atlanta, Georgia

Group Name: _______________________________

List below the persons wishing to attend Air Care on April 28. If you will need a rental car, please include a credit card number in the space provided. Credit cards are to be used for rental cars only. Conference and dinner fees will require payment by check.

PRINT NAME and indicate by name:  Dinner-$55;  Dinner Selection;  Tie-down;  Rental car

(as desired on name tag)

1) ________________________ Dinner: Y N  Fish or Steak   Tiedown: Y N   Car: Y N

Name on Credit Card: __________________________ Type of Card: Visa Amex MC

Card #:__________________________ exp. Date:______________

2) ________________________ Dinner: Y N  Fish or Steak   Tiedown: Y N   Car: Y N 

Name on Credit Card: __________________________ Type of Card: Visa Amex MC

Card #:__________________________ exp. Date:______________

3) ________________________ Dinner: Y N  Fish or Steak   Tiedown: Y N   Car: Y N

Name on Credit Card: __________________________ Type of Card: Visa Amex MC

Card #:__________________________ exp. Date:______________

4) ________________________ Dinner: Y N  Fish or Steak   Tiedown: Y N   Car: Y N

Name on Credit Card: __________________________ Type of Card: Visa Amex MC

Card #:__________________________ exp. Date:______________

5) ________________________ Dinner: Y N  Fish or Steak   Tiedown: Y N   Car: Y N

Name on Credit Card: __________________________ Type of Card: Visa Amex MC

Card #:__________________________ exp. Date:______________

(For additional persons continue the list on another copy of the form)

Number attending Conference ______x $25= ________ No. of dinners_____x $55=________

Total remitted: $___________ by included check # _________. (See note above about payments)

Please contact Jeanine Chambers at Angel Flight of Georgia if you have any questions regarding these arrangements. Phone: 770-452-7958 ext. 3 
Email:
jeanine1@mindspring.com or Fax: 770-452-7391.

FOR A COPY, PRINT or SAVE THIS PAGE or download the Word registration form file;
Go UP for conference information or to download the files

 

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