SEMINAR REGISTRATION FORM

 

The Coastal Empire Alliance Against Fraud

 

Please complete a separate registration form for each guest.

.

To register for the seminar please complete and fax this page to (912) 826-6144.  Guests

shall receive a Letter of Confirmation upon being registered for the seminar.

 

_____________________            ________________________________________________       

Salutation (Mr., Mrs. etc.)                First Name         Middle Initial          Last Name

 

________________________________________________________________________

Name of Business

 

________________________________________________________________________

Address (Street Number, Name, Room / Suite)                     P.O. Box Number

 

_____________________________________ / ______ / _________________________

City                                                                        State                               Zip Code

 

(_____) _____________________________          (_____) _________________________         

Area Code & Telephone Number                                            Area Code & Fax Number

 

________________________________________________________________________

Guest E-mail Address  (Where possible, Letter of Confirmations shall be forwarded via E-Mai)

 

REGISTRATION FEE:   

 

$ 375.00 per person              Businesses registering two or more guests on or before April 15 shall receive a free copy of  the 2003 U.S. I.D. Checking Guide. An excellent tool to effectively identify bogus I.D. Cards, Driver's Licenses, & Credit Cards.

 

$ 425.00 per person On or after April 16, 2003

 

$ 150.00 Single Day Rate  Circle day of attendance: Monday / Tuesday / Wednesday

 

METHOD OF PAYMENT: Seminar Registration Fees may be made paid by Credit Card, Check, or Money Order).  To pay by Credit Card please complete the following form.

 

________________________________________________________________________

Type of Credit Card :  American Express, MasterCard, Visa, Discover, etc.

 

_________________________________      ____________________________________

Credit Card Number                          3 Digit Control Number From Rear of Card

 

_________________________________               ____________________________________  

 Name of Issuing Financial Institute                                 Expiration Date

 

___________________________________       _________________________________     

Printed Name (as appearing on the card)                            Authorized Signature (as appearing on the card)

 

. To register for the seminar please PRINT, compete and fax this page to (912) 826-6144.

SPECIAL ACTIVITIES

 

Just a few of the many activities available to guests during this year's seminar include Para-Sailing, Ski Jets, Deep Sea Fishing, Golf, and Dancing.  Join us for dinner and an evening of fabulous food and entertainment on: 

 

Monday, May 19, 2003  -  6:00 p.m.

 

Dolly Parton’s

Dixie Stampede

Dinner & Show

 

Four-course Feast!

A Tender Whole Rotisserie Chicken, Hickory Smoked Barbecued Pork Loin, Dixie Stampede's Original Creamy Vegetable Soup, Delicious Homemade Biscuit, Hot Buttered Corn on the Cob, Herb-based Potato, Dixie's very own Specialty Dessert, Unlimited Pepsi, tea or coffee

 

Name of Guest: _________________________________________

 

                                     Number of Adults: _______  x $40.00 = $ _______

                                                                                 

                                                            Children 4 - 12: _______ x $20.00 = $ _______

                                                  

                  Children under 4 on lap of parent: _______ x Free    =  $     0

 

                                                                        Amount Due:   $ _______

 

METHOD OF PAYMENT: Special Activities may be made paid by Credit Card, Check, or

Money Order).  To pay by Credit Card please complete the following form:

 

Please check here _______ if you wish to charge the cost of your Special Activities to the Credit Card listed above or to charge the cost of Special Activities to another Credit Card please complete and fax the following form to (912) 826-6144 along with your Seminar Registration Form.

 

________________________________________________________________________

Type of Credit Card :  American Express, MasterCard, Visa, Discover, etc.

 

_________________________________      ____________________________________

Credit Card Number                          3 Digit Control Number From Rear of Card

 

_________________________________               ____________________________________  

 Name of Issuing Financial Institute                                 Expiration Date

 

___________________________________       _________________________________     

Printed Name (as appearing on the card)                            Authorized Signature (as appearing on the card)

 

To sign-up for Special Activities please complete & fax this page to (912) 826-6144

with your Seminar Registration Form

Payment By Check or Money Order: Registration Fees and Special Activities may be paid by Check or Money Order by sending your payment to: 

 

The Coastal Empire Alliance Against Fraud

P.O. Box 60068

Savannah, Georgia 31420

 

Refund Policy:  Full refund if registration canceled on or before 1 May 2003 minus $50.00 handling fee. 50% refund after May 1, 2003 and before May 10, 2003.  No refund after May 10, 2003. 

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