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
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