ANG Seminar February 2018 - 46
SEMINAR 2018, WASHINGTON, DC
Registration Form
One form per person.
BOX ONE: REGISTRATION FEE
REGISTRATION
Name: _____________________________________________________
Print: First
Last
Street
__________________________________________________________
State
Zip
ANG Membership Number: ________________________________________
Email Address: ________________________________________________
Phone: ________________________ ____________________________
Primary
Secondary
Please provide a Contact Name & Phone Number in Case of Emergency:
______________________________
Name
r First-Timer
r Need a roommate
$125
Non-ANG Member Fee, Non-refundable (banquet tickets dependent
on class package)
$175
__________________________
Phone
r Life Patron
r Need special assistance
r Member-at-Large
r Golden Needle Society Member
Dietary restrictions: r None
r Kosher
rVegetarian
r Diabetes
r Food Allergies: _______________________________________________
r Other Needs:_________________________________________________
BOX TWO: CLASS PACKAGE FEE
(KIT FEES ARE BILLED LATER)
SELECT ONE PACKAGE
PRICE
Friend of ANG (classes and banquets are not included)
$0
One Day of Classes Package (no banquets are included)
$150
Two Days of Classes Package
Includes one banquet ticket. You must include a banquet option:
r Welcome Banquet r Farewell Banquet r No Banquet
$350
Three Days of Classes Package
Includes one banquet ticket. You must include a banquet option:
r Welcome Banquet r Farewell Banquet r No Banquet
$400
Four Days of Classes Package
Includes two banquet tickets. You must include a banquet option:
rWelcome Banquet r Farewell Banquet r No Banquet
$550
Five Days of Classes
Includes two banquet tickets. You must include a banquet option:
r Welcome Banquet r Farewell Banquet r No Banquet
$630
BOX THREE: FACILITIES USAGE FEE
May we include your name and contact information in the Participant's Handbook?
r Yes r 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. 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 and I agree to the
terms and conditions listed therein.
Signature
Print Name
Date
VOLUNTEERING
r Class Angel
r Shop
PRICE
You must pay this fee if you take more than one day of classes and
are not registered for at least two nights in the ANG hotel block.
BOX FOUR: OPTIONS
QTY
PRICE
$90
Farewell Banquet
$90
Life Patron Luncheon
$70
ANG Tote Bag
$40
TOTAL OPTIONS COST:
BOX FIVE: TEACHERS & VENDORS
(Registration must be paid to reserve a table)
QTY
$35
Expo! Table (8' full only)
$125
r Please charge my credit card: r Visa
r MasterCard
r American Express
__________________________________ _______________________
Card Number
Expiration Date
Name on Card: _________________________________________________
Signature: ___________________________________________________
46 | Registration Form
TOTAL
TOTAL TEACHERS & VENDORS COST:
Box One: Registration Fee
r Check (made payable to ANG) enclosed
PRICE
Teachers' Showcase Table
BOX SIX: TOTALS
Please pay only the 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 16, 2018,
whichever is first, or you will be dropped from these classes. You will not receive any class
materials until the balance due is paid.
TOTAL
$15
Tote Bag Shipping (if not picked-up at Seminar)
r Hospitality
r Anywhere
TOTAL
$250
Welcome Banquet
__________________________________________________________
__________________________________________________________
TOTAL
TOTAL CLASS PACKAGE COST:
If you are sharing a room with someone, please provide your roommate's name:
Can you help Seminar in the following areas?
r Auction
r Exhibit
TOTAL
TOTAL REGISTRATION FEE COST:
Billing Address: _______________________________________________
City
PRICE
Member Required Fee, Non-refundable
Box Two: Class Package Fee
Box Three: Facilities Usage Fee
Box Four: Options
Box Five: Teachers and Vendors
GRAND TOTAL
Pay only the required Registration Fee of $125 for members
or $175 for non-members with this Registration Form
Please send your form and $125 fee to:
American Needlepoint Guild, Attention: Registrar
1120 Route 73, Suite 200
Mount Laurel, NJ 08054-5113
Fax 856-439-0525
AMOUNT
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