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REGISTRATION FOR ANNUAL MEETING

JUNE 21 & 22, 2011

President Abraham Lincoln Hotel and Conference Center

701 E Adams Street

Springfield, Illinois 62701

 

REGISTRATION FORM

 

Name:

 

 

Name of spouse/guest if attending:

 

 

Officer Title:

 

 

Chapter Name:

 

 

Address:

 

 

City:

 

 

State:

 

 

Zip:

 

 

Phone:

 

 

Email Address:

 

REGISTRATION FEES (Per Person)

 

GENERAL FEE                 ______________    REGISTRANT $75           ______________    SPOUSE/GUEST $75

TUESDAY ONLY              ______________    REGISTRANT $75           ______________    SPOUSE/GUEST $75

WEDNESDAY ONLY      ______________    REGISTRANT $25           ______________    SPOUSE/GUEST $25

DINNER ONLY                 ______________    REGISTRANT $35           ______________    SPOUSE/GUEST $35

 

TOTAL PAYMENT            $___________                          Please Make Checks Payable to SUAA

    (SORRY, WE ARE UNABLE TO ACCEPT CREDIT CARDS.)

 

 

PLEASE RETURN REGISTRATION BY THURSDAY, JUNE 16TH WITH PAYMENT TO:

State Universities Annuitants Association

217 E. Monroe, Suite 100

Springfield, IL 62701

217-523-4040

Text Box: PLEASE NOTE THAT REGISTRATION DOES NOT INCLUDE HOTEL ACCOMMODATIONS, PLEASE CONTACT THE PRESIDENT ABRAHAM LINCOLN HOTEL @217-544-8800 OR 1-866-788-1860  

 

 

 

 

 


THIS FORM MUST BE COMPLETED FOR EACH REGISTRANT UNLESS THE REGISTRANT IS A SPOUSE OR GUEST OF ANOTHER REGISTRANT WHO HAS COMPLETED THIS FORM.