Page 4 - January 2019 BOD Meeting - Mailer and Special Invitee Fee Waived Registratoin Form

NABCA JANUARY BOARD OF DIRECTORS MEETING 2019

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

SPOUSE TELEPHONE SPOUSE E-MAIL
EMERGENCY CONTACT TELEPHONE
ITINERARY

(This information is crucial for food functions & rooming guarantees. Thank you for your cooperation.)
Registrant Arrival 01/_______ /19 _______ AM/PM Departure 01/_______ /19 _______ AM/PM
Spouse Arrival 01/_______ /19 _______ AM/PM Departure 01/_______ /19 _______ AM/PM
Yes, I will be attending the dinner at the Healing Garden on 1/7. Yes, I will be attending the dinner at the Social Eatery on 1/8.
LODGING INFORMATION

NABCA has secured a room rate of $299.00 for single/double occupancy plus 12% tax.
The room rate includes complimentary internet access and wi-fi at the hotel, beach club and golf club, unlimited local phone calls, complimentary
exercise classes, golf practice area privileges with clubs and shoes, bicycle use at hotel and beach club, tennis court usage and golf club with
racquets and balls, beach umbrellas, use of snorkels, masks and fins, body boards, use of kayaks and paddleboards at hotel, use of fishing poles at
hotel, beach club and golf club, complimentary 24-hour access to Fitness Center and scheduled shuttle service to St. Armands Circle, Beach Club on
Lido Key and Golf Club.
Room Type: ____King ____Queen/Queen Other Requests: __________________________________________________________
(including dietary restrictions or food allergies)
CANCELLATION INFORMATION

All rooms are guaranteed for late arrival by NABCA. In order to avoid penalties, please notify NABCA no later than 72 hours prior to arrival
of any cancellations or changes in stay.
CONFIRMATION

Please note: You will receive a reservation confirmation email directly from the hotel. NABCA will send a second confirmation email with
further important details 1-2 weeks prior to the meeting.
PAYMENT INFORMATION
REGISTRATION FEE WAIVED
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
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
RETURN BOTH THE REGISTRATION FORM AND THE ACTIVITY FORM

NO LATER THAN FRIDAY, DECEMBER 7, 2018! Page 1 of 2