Registration Form for Southeast Region  Annual Retreat

April 23-25, 2010

 

Please Make Checks payable to: ACT Region 17 and return by April 15, 2010

 Mailed to Mrs. Deborah Kalinyak, P.O. Box 411492, Melbourne, FL 32941-1492

 

Name ______________________________PHONE_________________________                                                                                                                                                                

ADDRESS_____________________________________CITY_______________________State_______ZIP___________

CHOICE OF ROOMMATE

 

ON  OR BEFORE  APRIL 15:                                          AFTER APRIL 15:

ACT MEMBER $200.00                                                    $215.00

Non ACT MEMBER $225.00                                           $235.00

DEPOSIT $50.00

This includes registration, room, and six meals. A $50.00 deposit is required with registration. All accommodations are double occupancy unless special arrangements are made.