ANG Seminar February 2017 - 38
SEMINAR 2017, ANAHEIM
Registration Form
**PLEASE PHOTOCOPY THIS FORM
Instructions for completing this form may be found on page 37. PLEASE PRINT. One form per person.
REGISTRATION
Name:
BOX ONE: REGISTRATION FEE
Required Fee, Non-refundable
Print: First
Billing Address:
BOX TWO: CLASS PACKAGE FEE
(KIT FEES ARE BILLED LATER)
Street
State
SELECT ONE PACKAGE
Zip
Friend of ANG (classes and banquets are not included)
ANG Membership Number:
Email Address:
Primary
Secondary
Please provide a Contact Name & Phone Number in Case of Emergency:
Name
Phone
First-Timer
Life Patron
Member-at-Large
Need a roommate
Need special assistance
Golden Needle Society
Member
Have dietary restrictions: Kosher
Vegetarian
Diabetes
Food Allergies:
May we include your name and contact information in the Paticipant's Handbook?
Yes No
SIGNATURE: I release the American Needlepoint Guild, Inc. from any liability for any
related financial loss, theft, property damage, or personal injury resulting from registering
for or participating in, attending any or all functions at Seminar, and traveling to and
from the Seminar. ANG reserves the right to cancel this function without penalty. The
total amount of any liability of ANG will be limited to a refund of registration fees
collected, less the cancellation fees described on page 33. I accept the possibility that
my photograph or photographs of events related to Seminar may be used for future
promotional purposes by the American Needlepoint Guild. I also certify that I have read
the registration, cancellation, and payment information for Seminar and the hotel on
pages 33 through 35 and I agree to the terms and conditions listed therein.
$125
PRICE
TOTAL
$150
$380
Gold Package
Includes two banquet tickets and you must include a
banquet option:
Welcome Banquet Closing Banquet No Banquet
$610
Platinum Package
Includes two banquet tickets and you must include a
banquet option:
Welcome Banquet Closing Banquet No Banquet
$840
TOTAL CLASS PACKAGE COST:
BOX THREE: FACILITIES USAGE FEE
PRICE
You must pay this fee if you take two or more days of classes
and do not stay at the Seminar hotel.
BOX FOUR: OPTIONS
QTY
PRICE
$80
Closing Banquet
$80
Life Patron Luncheon
$55
TOTAL
TOTAL OPTIONS COST:
QTY
Teachers' Showcase Table
Date
TOTAL
$200
Welcome Banquet
(Registration must be paid to reserve a table)
Print Name
$0
Silver Package
Choose one and you must include a banquet option:
Welcome Banquet Closing Banquet No Banquet
BOX FIVE: TEACHERS & VENDORS
Signature
PRICE
TOTAL
$35
Expo! Table (8' full table only)
$100
TOTAL TEACHERS & VENDORS COST:
VOLUNTEERING
Can you help Seminar in the following areas?
Auction
Exhibit
Class Angel
Anywhere
Shop
Hospitality
BOX SIX: TOTALS
Box One: Registration Fee
Box Two: Class Package Fee
Please pay only the $125 Registration Fee when you submit this form. Your balance due
invoice will include the kit fees for the classes you are registered for and the appropriate
Class Package Fee. You must pay this balance due within 45 days of receipt of the invoice
or by July 21, 2017, whichever is first, or you will be dropped from these classes. You will
not receive any class materials until the balance due is paid.
Check (made payable to ANG) enclosed
Please charge my credit card: Visa
MasterCard
Card Number
Expiration Date
Signature:
$125
Bronze Package (banquets are not included)
If you are sharing a room with someone, please provide your roommate's name:
Name on Card:
TOTAL
Last
City
Phone:
PRICE
Box Three: Facilities Usage Fee
Box Four: Options
Box Five: Teachers and Vendors
GRAND TOTAL
Pay only the required Registration Fee of $125
with this Registration Form
American Express
Please send your form and fee of $125 to:
American Needlepoint Guild, Attention: Registrar
2424 American Lane
Madison, WI 53704-3102 or
Fax to: 608-443-2474
38 ANG Seminar 2017
AMOUNT
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