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USA Council of Serra International

Super Weekend Registration

Instructions

This form may be used to register for the USA Council of Serra International Super Weekend. Please complete this online registration form including your address and personal contact information particularly your phone, fax number, and email so that we can confirm your registration via telephone, the USA Council will contact you once we receive the completed registration.

Do not include your credit card information anywhere on this form.

Please provide all possible contact information, so our meeting registrations will be complete.

When you are finished filling in the form, click the Send button.

Please register before Dec 15, 2010 for Super Weekend January 14-16, 2011.

Meeting Registration
Yes, I would like to register for Super Weekend Annual Meeting!
Yes, I WILL need a room for the weekend. (Please complete both the meeting and hotel reservation sections.)
No, I WILL NOT need a room for the weekend. (Please complete the meeting registration section only.)
Serra Club of

Contact Information
Name:
Address 1:
Address 2:
City:
State:Two-character US State
Zip Code:
Home Phone:include area code
Work Phone:include area code
Mobile Phone:include area code
Email Address:
Name Tag1:
Committee(s):
Position:
Additional Registrant Name:
Name Tag2:
Committee(s):
Position:

Hotel Reservation
The room rate is TBD per night, plus taxes. Because there are a limited number of rooms available at the Crown Plaza O'Hare-Chicago, Rosemont, IL please complete your registration form by Dec 15, 2010.
The hotel has also requested that all rooms be guaranteed with a credit card number, therefore the USA Council Office will contact to confirm your hotel reservations and credit card information.
Type of room:
King size Double/double
Smoking Room Non-Smoking Room
Arrival:
Day:  Time:
Departure:
Day:(Checkout time is 12:00 PM)
Rooming with:
Name:

Fees
Registration Fee:
per registrant
Dinner:
per registrant
Additional dinners:
@ $50.00 per person, please add the additional dinners to your total fees.
Total Fees:
Registration fees plus dinner(s)
Balance due:
Make checks payable to USA Council of Serra International. You may also charge registration/dinner charges to your credit card.
Yes, I would like to use my credit card. The USA Council Office will contact by phone to confirm your registration fees and credit card information.
Special Instructions:

Please send information on optional recreational activities.
Please enter the security code: 1262

 

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