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AICP Joint Chapter Registration FormGulf States | Heartland | Midwest | New England | Northwest | South Central
Who: You!
What: Your chapters have joined forces to put together a night you won’t forget. Enjoy networking, dinner, drinks & dancing with a live band as we cruise Puget Sound aboard the Spirit of Seattle.
When: Tuesday, October 3, 20176:00 pm to 9:00 pm(Boarding starts at 5:30. We will depart promptly at 6:00.)
Where: Pier 55, Downtown Seattle
How: Your registration payment gets you on board.Before September 15th: AICP Members: $60 AICP Guests: $75
After September 15th: AICP Members: $85 AICP Guests: $100
Space is limited, so don’t delay!
For questions, please contact any of the following:
Gulf States Chapter Roger Osgood [email protected] 678-795-4414Heartland Chapter Vickie Goodman [email protected] 816-391-2735Midwest Chapter Dave Reynolds [email protected] 614-937-8022New England Chapter Sara Thomas [email protected] 857-224-2397Northwest Chapter Bri Dahl [email protected] 800-366-5551, x3096South Central Chapter Lynda Peña [email protected] 512-689-4535
Don’t Miss the Boat!
AICP Joint Chapter Registration FormGulf States | Heartland | Midwest | New England | Northwest | South Central
We wish to extend a special thank you to our generous sponsors listed below:
AICP Joint Chapter Registration FormGulf States | Heartland | Midwest | New England | Northwest | South Central
AICP Joint Chapter Registration FormGulf States | Heartland | Midwest | New England | Northwest | South Central
REGISTRANT INFORMATION
REGISTRANT:
COMPANY:
EMAIL ADDRESS:
TELEPHONE:
CHAPTER AFFILIATION:
PARTICIPATING CHAPTERS:
☐ GULF STATES
☐ HEARTLAND
☐ MIDWEST
☐ NEW ENGLAND
☐ NORTHWEST
☐ SOUTH CENTRAL
NON-PARTICIPATING CHAPTERS:☐ GREAT LAKES
☐ MID-ATLANTIC ☐ WESTERN
PAYMENT INFORMATIONPLEASE NOTE: PAYMENT MUST BE RECEIVED BY SEPTEMBER 21ST
EARLY BIRD RATES ARE DUE BY SEPTEMBER 15TH
CREDIT CARD
CREDIT CARD PAYMENT IN THE AMOUNT OF: $
CREDIT CARD TYPE: ☐ VISA ☐ MASTERCARD ☐ AMERICAN EXPRESS
NAME ON CARD:
CARD NUMBER:
EXPIRATION (MM/YY):
SIGNATURE:
CHECK:
☐ Check enclosed ☐ Check to follow, please reserve my space
MAKE PAYABLE TO AICP AND SEND TO THE MAILING ADDRESS AT THE BOTTOM OF THIS FORM.PLEASE NOTE, IF YOU NEED TO WAIT FOR A COMPANY CHECK, YOU MAY RESERVE YOUR SPACE BY EMAILING THIS REGISTRATION FORM TO ONE OF THE CONTACTS LISTED ON THE PREVIOUS PAGE.
MAILING ADDRESS:
PLEASE MAIL THE REGISTRATION FORM AND CHECK OR CREDIT CARD INFORMATION TO OUR SECURE LOCKBOX AT:
AICP11130 SUNRISE VALLEY DR, STE 350RESTON, VA 20191
AICP Joint Chapter Registration FormGulf States | Heartland | Midwest | New England | Northwest | South Central
