2011 CONVENTION EARLY REGISTRATION FORM

(PLEASE PRINT OUT, FILL IN, AND RETURN WITH YOUR PAYMENT)

 

Member Name:       _______________________________________________

Address:                  _______________________________________________

                                    _______________________________________________

Telephone:              (W)_________   (C)__________  (H)_________   (F)_________

E-mail:                       _________________________________

Arrival Date:            ________________           Departure Date:  ________________

Number of Adults:   ____  Children:   ____   Guests:   ____(see over)

For Guests: Please provide full and complete contact information concerning your guests including all names, addresses, phone numbers and email addresses on the reverse side of this form.

IF YOU ARE NOT STAYING AT THE HOTEL, PLEASE PROVIDE US WITH YOUR LOCAL ADDRESS AND TELEPHONE NUMBER

Member Early Registration Fee:                       $_______  @ $550.00 per couple

Non-Family Guest Early Registration Fee:    $_______  @ $550.00 per couple

***ALL REGISTRATION FEES RECEIVED AFTER DECEMBER 1, 2011 ARE $650.00 PER COUPLE***

If your convention registration is canceled by December 15, 2011, we will fully refund your registration fee.

Return your completed advance registration form and check payable to TER to:

 

                                                ALAN M. TEPPER, ESQUIRE
                                                National Executive Director
                                                133 Paisley Place
  
                                             Hainesport, New Jersey 08036

(609) 864-1838

tepesq@verizon.net or director@ter-law.org