Name:____________________________________Company:_______________________________________
Address:_______________________________City:_________________________State:_________________
Zip:__________ Country: ___________________ Business Phone:________________________ Home Phone:_________________________
Registration Fee Schedule
(All costs include: Continental breakfast, lunch, and break-time refreshments)
| Early Registration (Must be received before July 1st) |
Late Registration (If received after July 1st) |
| Member Rates: ( ) All five days $372.00 |
Member Rates: ( ) All five days $430.00 |
| Daily:$95.00 (Check which days you will attend) ( )Mon ( )Tues ( )Wed ( )Thurs ( )Fri |
Daily:$108.00 (Check which days you will attend) ( )Mon ( )Tues ( )Wed ( )Thurs ( )Fri |
| Non Member Rates: ( ) All five days $522.00 |
Non Member Rates: ( ) All five days $560.00 |
| Daily:$130.00 (Check which days you will attend) ( )Mon ( )Tues ( )Wed ( )Thurs ( )Fri |
Daily:$150.00 (Check which days you will attend) ( )Mon ( )Tues ( )Wed ( )Thurs ( )Fri |
REGISTRATION TOTAL: _________________
Wednesday Evening Business Meeting, Banquet (all you can
eat buffet) & Prize Drawing: $36.50/person
Attendee #1 Name: ____________________________ Attendee #2 Name: ___________________________
Attendee #3 Name: ____________________________ Attendee #4 Name: ___________________________
BANQUET TOTAL: _________________
Extra Guest Lunches: $17.00/day
(Please list names and check days of attendance)
Guest #1 Name: _______________________________
Guest #3 Name: ______________________________
(
)Mon ( )Tues ( )Wed ( )Thurs ( )Fri
( )Mon ( )Tues ( )Wed ( )Thurs ( )Fri
Guest #2 Name: _______________________________
Guest #4 Name: ______________________________
( )Mon ( )Tues ( )Wed ( )Thurs ( )Fri (
)Mon ( )Tues ( )Wed ( )Thurs ( )Fri
GUEST LUNCH TOTAL: _________________
| Please fill out this form and send it, along with your payment to: Mita, International Convention Registration 376 Old Woodbury Rd. Southbury, CT 06488 |
Select Payment Type:
TOTAL AMOUNT: ( ) Check#_________ $________________ ( ) Visa/MC#:_____________________________ Name of cardholder:________________________ Expiration Date:___________ Credit card payments may be faxed to: (203) 264-9304 |