483 Tenth Avenue, Suite 525 | New York, NY 10018 | Phone 212.5 - PDF document

��483 Tenth Avenue, Suite 525 | New York, NY 10018 | Phone 212.582.0343 | www.clubhouseintl.org The Clubhouse InternationalSeminarDenverColoradoOctober 24, 201The 1 ��483 Tenth Avenue, Suite 525 | New York, NY 10018 | Phone 212.582.0343 | www.clubhouseintl.org SeminarDates to Remember anuary, 201 Registration begins!September 30, 2015Full Payment or Registrationfinal names all participantsduelubhouse International SeminarRegistration Fees Full Seminar PackageSingleDouble ClubhouseInternational member Clubhouses500(per person)Nonmember Clubhouses700350 (per person)Daily ParticipantsThe cost for daily participants (those not staying in the seminar hotel) includes Seminar registration and materials, the welcome reception, four lunches and the Gala Banquet.Reservations for the Hotel and Seminar will be made on a firstcome, firstserved basis. A nonrefundable $100.00 (USD) per person deposit is required for all reservations. Deposits will be applied to final payments, which are due September 30,2015Please address all questions to the address given below. ��483 Tenth Avenue, Suite 525 | New York, NY 10018 | Phone 212.582.0343 | www.clubhouseintl.org Registration Form Please fill out this form and return it with a $100.00 (USD) nonrefundable deposit for each seminar participant. The balance of the full payment is due by September 30, 201Requests for refunds will not be considered after September 30thNOTE: If you do not yet know the names of actual participants, just let us know how many single rooms and how many double rooms you will need. Please send us actual names no later than September , 201as the hotel needs to have an accurate list of guests’ names by this date.Please make the following reservations for us at the Marriott Denver Tech CenterClubhouse: ______________________________________________________________Address:_________________________________________________________________City: __________________________________State/Province/Country: ___________________ZIP/Postal Code:_________________Phone: ______________________________ Fax:_______________________________Email address: _______________________ Contact Person:______________________Are you from a Clubhouse International member Clubhouse?Yes_______No______Single Room:1)__________________________________2)__________________________________3)__________________________________4)__________________________________Double Room:1)__________________________________ sharing with__________________________________2)__________________________________ sharing with__________________________________3)__________________________________ sharing with__________________________________4)__________________________________ sharing with__________________________________ ��483 Tenth Avenue, Suite 525 | New York, NY 10018 | Phone 212.582.0343 | www.clubhouseintl.orgDaily Participants: (those not staying in the Seminar Hotel)1)__________________________________)__________________________________3)__________________________________4)__________________________________Extra hotel nights two days before or after the Seminar (based on availability):Single room:1)__________________________________2)__________________________________Double room:1)__________________________________sharing with2)__________________________________Please let us know if you have any special dietary requirementsor other accommodation needs (wheelchair accessible room, sign language services, etc.)by August 15, 2015Registrant name/special dietary requirement ___________________________________*We will try to accommodate special dietary needs and notify you if unable to do so.Wheelchair access _____ Sign Language Services _____IMPORTANT NOTE:After each name, please indicate “M”for member, “S”for staff, or “B”for Board member/member of an Advisory Group. This will help us have a proportional idea of attendance at the Seminar. Thank you.Please duplicate this form as needed, and make a copy for yourself. Return it with the appropriate deposit ($100.00 USD per person).Make Checks or Money Orders payable to: lubhouse International Seminar ailto: Clubhouse International 483 Tenth Avenue, Suite 52New York, NY 10018Amount Enclosed: _________________Credit Card Payments or Wire Transfers (please add an additional $25.00USD to cover wire transfer feesonlyContact Maggie Figueroa at 2125820343 or via email at mfigueroa@clubhouseintl.org