Last Name: First Name: MI:

Address: City: State: Zip+4:

Home Ph: Work Ph: Home email:

Chapter Affiliation: Regional Affiliation:

Are you a first timer? Yes: No: Special Dietary Needs?

FULL PACKAGE INCLUDES: WORKSHOPS, GENERAL SESSIONS, PARADE OF CHAPTERS, LUNCHEON, BANQUET, & BREAKFAST
COMPLETE PACKAGE MEMBERS NON-MEMBERS
Early Registration - prior to February 15, 2010 $190 $195
Registration – February 16 -March. 20, 2010 $200 $205
Late Registration - March 21, 2010-April 3, 2010 $210 $215
On Site Registration- After April 3, 2010 Cash/Credit Only $225 $230
EXTRA TICKETS EXTRA TICKET PRICE # TICKETS AMOUNT PAID
Workshops only $75
Luncheon only- Friday $65
Parade of Chapters–Friday $65
Banquet only – Saturday $75
Breakfast only-Sunday $35
Special Trip for Retiree only $40 If you do not purchase full registration Total Registration:
Total Amount Submitted (Registration including extra tickets) Grand Total
Friday Unity Day T-Shirts S, M, L, XL, XXL $12.00
Friday Unity Day T-Shirts XXXL & XXXXL $13.00
Accepted Methods of Payments: Cash, Check, (Fees for NSF Checks $35), Money Order, and Credit Card, Register on line at www.aplus.cc
Visa: Master Card: Discover: Others:
Credit Card Number: Expiration Date:
Signature for Credit Card Approval:
Make check/money orders payable to A-PLUS National Convention. No personal checks accepted after March 20, 2010. Written
cancellation is required no later than April 2, 2010. Mail completed form to:
A-PLUS NATIONAL CONVENTION, ATTN: REGISTRATION, P O Box 11852, St. Louis MO 63105-1852
For information contact Tara Shackleford, Chair at 314.619-2961 (c) or Gail Lofton, Co-Chair at 214.681.2493(c)

HOTEL INFORMTION - Cut-off Date for Reservation: April 7, 2010 - Room rates $99 single/double per night plus taxes.
Call the Oak Brook Hills Marriott Resort at 1-800-228-9290 and ask for the A-PLUS rate to Reserve Your Room Today!
PARKING: Free per night