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Advanced Registration Form

Name: _____________________________________ Spouse/Significant Other: _______________________________
Company: __________________________________ Telephone: ________________________________
Email: _____________________________________ Spouse Email: ________________________________________

Registration Fees

Single Registration: $380 $_______ Couple Registration: $580 $________
(includes a Reverse Raffle Ticket, Welcome Reception, (includes two Reverse Raffle Tickets, Welcome Reception,
Dessert Extravaganza and President’s Dinner) Dessert Extravaganza and President’s Dinner)

Non-Members: Individuals from non-member companies will be charged a $150 additional convention registration fee.
Please add this charge to your total registration amount.

Convention Activities and Events

Additional tickets are available for family members/ Tuesday
guests not involved in the propane industry and, Fishing: $180 #_____ $_______
therefore, not paying convention registration fees. Extra (Minimum of 10 needed to confirm reservation. Fee in-
tickets must be purchased to attend events for non- cludes everything needed to fish plus food, drinks, tip and
convention attendees, no exceptions. fish cleaning)
Golf Tournament: $150 #_____ $_______
Sunday (Fee includes green fee, cart, drinks, box lunch and prizes)
Welcome Reception (included in registration) Names (Would like to Play with) Handicap
Extra Adult Ticket: Free #_____ __________________________________ __________
(Cash Bar) __________________________________ __________
Child Ticket (17 and under): Free #_____
Hangin’ on the Beach: $30 #_____ $_______
Monday (Fee includes one lounge chair, shared umbrella, snacks
Extra Reverse Raffle Ticket: $50 #_____ $_______ and beverages)
Dessert Extravaganza (included in registration) President’s Dinner (included in registration)
Extra Adult Ticket: $35 #_____ $_______ Extra Adult Ticket: $120 #_____ $_______
Child Ticket (17 and under): Free #_____ Extra Child Buffet (15 & under): $45 #_____ $_______

Total Registration Amount $___________

Hotel Information (12 Via de Luna Drive): Donations are needed for the Silent Auction. Contact
To make your room reservation at the Hilton Hotel for the LPGA office with your item information or fill out
June 27-30, 2021 call: 1-866-916-2999 or 1-850-916-2999. and return the attached form. Thank you in advance!
To book online, go to: www.hiltonpensacolabeach.com. Convention Cancellation Policy:
Use group/convention code: LPGA Since we have to give a guaranteed number of
Room Rates Start at $269
Room Block Reservation Deadline is May 26, 2021! attendees for events several days in advance, the
cancellation policy will be as follows:
Return Form and Payment to: *Full refund on or before May 17th
Louisiana Propane Gas Association *Half refund on or between May 17th-May 31st
13144 Perkins Road, Suite A, Baton Rouge, LA 70810 *No refund on or after June 1st
Phone: 225-763-8922, Fax: 225-763-8989 If you fax or email your registration form, you are
Email: marica@ccilouisiana.com
Make check payable to Louisiana Propane Gas Association considered pre-registered and must call to cancel
Pay online with credit card: www.Paypal.me/LAPropane your registration!

12 Alabama Propane Gas Association | May / June 2021