Full Names:

Names to be used on name tags:

Address:

City, State, Zip:

Phone:

Wedding Date:

Email:

Years Married:

Friday Leadership In-Service

q Yes, We will attend this.

Check one of these:

Enter 1^st & 2^nd choices

1st

2nd

Saturday Program Attendance

Preferences:

Mini-Retreat  __   OR

  Workshops ___

Session 1 (A, B, or C):

Make choices:

Session 2 (D, E, or F):

Session 3 (G, H or I):

Saturday Dinner

Will Attend:  ____  (Y or N)

Attendees, please make one choice per person.  Indicate # for each: 

Roast Beef:

Grilled Salmon:

Chicken Marsala:

Vegetarian:

Special Needs:

Sunday Breakfast

Will Attend:  ___  (Y or N)          Indicate number:

Are you first time conference attendees?  (Y or N):

Check if you receive the Florida ACME newsletter:

Check if you receive the National ACME newsletter:

Amount Enclosed.  (See rates below.)

Make check payable to Florida ACME.

Conference Fee:

Registration:    Postmarked by 8/25/05:  $149

                         Postmarked after 8/25/05:  $169

Refund policy: 

Before 9/1/05: Full refund of Conference Fee

After  9/1/05: 50% refund of Conference Fee

The fee includes two meals (Saturday dinner & Sunday breakfast), Friday snacks, and materials.

Scholarship money is available for the conference fee.

See brochure for more information.

Send completed form and check to Registrar Couple:

John and Maxine Roy

7103 Cumberland Place

Tampa, FL  33617

Phone:  813-985-3266

Email: maxineroy@mybluelight.com