Page 4 - NABCA Sept BOD Mailer and Registration Form

NABCA SEPTEMBER BOARD OF DIRECTORS MEETING 2017

REGISTRATION FORM

REGISTRANT NAME BADGE NAME

ORGANIZATION

ADDRESS

CITY, STATE, ZIP E-MAIL

TELEPHONE CELL PHONE

ASSISTANT NAME ASSISTANT E-MAIL ASSISTANT TELEPHONE

SPOUSE NAME BADGE NAME

TELEPHONE SPOUSE E-MAIL
ITINERARY

(This information is crucial for food functions & rooming guarantees. Thank you for your cooperation.)
Registrant Arrival 09/_______ /17 _______ AM/PM Departure 09/_______ /17 _______ AM/PM
Spouse Arrival 09/_______ /17 _______ AM/PM Departure 09/_______ /17 _______ AM/PM
Yes, I will be attending the dinner at the Quartz on 9/17. Yes, I will be attending the dinner at Mulligans on 9/18.
LODGING INFORMATION

NABCA has secured a room rate of $290.00 for single/double occupancy plus 9% State and Hotel occupancy tax.
The room rate includes valet parking, on-property shuttle service, Fitness Center access (not inclusive of wet areas), wireless internet,
local and toll free calls, outdoor pool access, in-room coffee or designated complimentary coffee areas, newspaper, 3:30 pm Art Tours
Sunday - Friday, Fallingbrook Mini Golf, tennis courts, carousel rides and hiking/winter trails access.
Room Type: ____King ____Queen/Queen Other Requests: ____________________________________________________
(including dietary restrictions or food allergies)
PAYMENT INFORMATION
REGISTRATION
I hereby authorize the National Alcohol Beverage Control Association to charge my credit card for the amount below. In the case of any issues or disputes concerning this
transaction I will notify NABCA promptly to rectify the situation prior to notifying my credit card company.

PRINT CARDHOLDER’S NAME AUTHORIZED SIGNATURE DATE
FEE WAIVED
Internal Use ONLY Auth#__________________ CC#______________________ Initial___________________ Date___________________
NOTE: Due to Payment Card Industry (PCI) compliance guidelines, all payments with credit card information MUST BE SUBMITTED
VIA SECURE FAX to 703.824.3377 or mail. NABCA cannot accept emails that include credit card information.

This portion of the form will be shredded immediately after processing.
REGISTRATION FEE: $995.00 CHECK ENCLOSED (payable to NABCA) -or-

/ $
CREDIT CARD NUMBER EXPIRATION DATE AMOUNT
CONFIRMATION CANCELLATION INFORMATION
Please note: You will receive a reservation confirmation email All rooms are guaranteed for late arrival by NABCA. In order to
directly from the hotel. NABCA will send a second confirmation avoid penalties, please notify NABCA 7 days prior to arrival of any
email with further important details 1-2 weeks prior to the meeting. cancellations or changes in stay.

RETURN BOTH THE REGISTRATION FORM AND THE ACTIVITY FORM
NO LATER THAN FRIDAY, AUGUST 18, 2017!

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