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2013 Fall Forum Registration Form October 18 - 19, 2013 | Austin, TX | Courtyard Austin Downtown/Convention Center Firm:
Address:
City, State / Prov., Zip / Postal Code: Phone:
Fax:
E-Mail Address:
Meeting Registration
(includes educational sessions, welcome reception, breakfast, lunch, breaks and Texas BBQ Party)
Member
Non-Member
FD/EMB Lic# $450 First Registrant___________________________________________________________________________
$550
$325 FD/EMB Lic# Additional Registrant______________________________________________________________________
$425
Guest(s)*________________________________________________________________________________ $150
$200
*Welcome reception, breakfast, lunch, breaks and BBQ Party only; no educational sessions
Additional Tickets:
Welcome Reception____________________________________________________________________ Qty: _____X $45 each Names of attendees _____________________________________________________________________ Texas BBQ & Honky-tonk Party tickets (Sat. night)__________________________________________ Qty: _____X $50 each Names of attendees _____________________________________________________________________ Sunday Gospel Brunch at Stubb’s (pay $20.95 on site) _________________________________________Qty: _____ Names of attendees _____________________________________________________________________ I am interested in signing up for Friday’s Dutch Treat Dinner (details to come)
Payment Information
TOTAL DUE:
My check is enclosed (payable in US dollars to OGR) Charge to my
AMEX Discover MasterCard Visa
Name on card:____________________________________________________________________________ Account #__________________________________________Exp. Date:_________Security Code:________ Signature:________________________________________________________________________________ Registration & Cancellation Policy: Full payment must accompany registration. If you are unable to attend, another staff member may attend in your place. If you must cancel, notify OGR in writing no later than 10 days prior to the meeting. Refunds will be processed minus a $75 administrative fee, and no refunds will be made if notified less than 10 days before the event or for no-shows. Americans with Disabilities Act: If you require special assistance while attending OGR’s Fall Forum, contact Jessica Smith at (800) 637-8030 or jsmith@ogr.org at least two weeks prior to the event. Mail form with payment to OGR, 3520 Executive Center Drive, Suite 300, Austin, TX 78731, or fax to (512) 334-5514.
Questions? (800) 637-8030
The Independent® | Fall 2013 13