First Name (required)

Last Name (required)

Email (required)

Street

City

State

Zip

Phone (daytime)

Phone (evening)

Dues-Paying Members Receive 10% Discount!

Full weekend including the Saturday Night Gala Schmooze Cruise

# in Party

$240

$215 for Dues-paying members

Saturday Night Gala Schmooze Cruise Only

# in Party

$150

$135 for Dues-paying members

Saturday & Sunday, No Cruise

# in Party

$75

$65 for Dues-paying members

Sunday Only

# in Party

$36

I/We would like to purchase commemorative T-Shirts at $ 20/each

Small:

Medium:

Large:

Xtra Large:

I/We will need transportation between the hotel and the events.

yesno

Please list the names of all other people in your party

Please tally your total amounts due: (Weekend/Cruise, donations,
t-shirts)

$

While we do prefer that you pay by check, if you would like to pay by credit card, you call Elliot at the office (732-442-1373).

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