IOGA of NY Annual Meeting
November 4-5, 2009
REGISTRATION FORM
Please use one form per registrant!
No refunds will be given on registrations after received but substitutions may be made.
Invoice Number:
Date:
* Name for Badge:
* Company:
* Address:
* City:
* State:
* Zip:
*Telephone:
Fax:
Email:
* Denotes Required Field
Price
Qty
Item Total
IOGA of NY Members
$350.00
Non-Member
$395.00
Spouse Registration
$60.00
(Includes cocktails reception & dinner only)
Spouse name for Badge:
** Please provide additional attendants name and contact information in the comment section below.
Total:
NOTE: A 3% Handling Fee will be added to ALL credit card orders.
Total for Credit Card Order:
DINNER ENTREE SELECTION:
Choose One for each person registered
1
2
Breast of Chicken w/Lemon Herb Sauce
1
2
Seared Salmon w/Dill Cream Sauce
1
2
Sirloin of Beef w/Mushroom Cabernet Demi Glaze
Since we are charged for all meals ordered, please let us know whether you will be joining us for each meal being served. Thank you!
1
2
Luncheon 11/04/09
1
2
Cocktail Reception 11//04/09
1
2
Dinner 11/04/09
1
2
Luncheon 11/05/09
PLEASE ENTER ANY COMMENTS OR QUESTIONS IN THE FIELD BELOW
Comments:
When you click on the SUBMIT button below you will be directed to either print the page for mailing with your payment to IOGA o fNY or you can continue to PAYPAL to make a secure online payment using a credit card.
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