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REGISTRATION

REGISTER ONLINE AT WWW.SCACS.ORG • Mail/Fax Registration to: SCACS Headquarters, P.O. Box 11405, Columbia, SC 29211 or Fax to: 803-252-7799 • Questions? Please call 803-419-0804. Deadline: Before June 19th or until rooms are sold out.

Company Name: Contact Person: Mailing Address: City/State/Zip: Phone: Mobile Phone: Email: Print each name as it should appear on the name badge. Each person must be registered individually.

TYPE Basic Package

*Please provide exact age of child/teen/young adult as of 07/16/16 with name. Member Non Spouse Child Teen Young Adult Mixology Member 3-11 12-16 17-21 Class

# OF PEOPLE

COST BEFORE 06/17

Golf

AFTER 06/19

Tues. Family Fun Night

AMOUNT

(member, spouse, up to two children) _____ $750 $850 = $ _____ Member (includes spouse) _____ $450 $550 = $ _____ Non-Member (includes spouse) _____ $550 $650 = $ _____ Child (3-11, includes meals) _____ $175 $200 = $ _____ Teen (12-16, includes meals) _____ $200 $225 = $ _____ Will teen be eating with parents? Y / N Young Adult (17-21, includes meals) _____ $225 $250 = $ _____ Will young adult be eating with parents? Y / N Mixology Class (Limit 50, first come, first serve) _____ $125 $150 = $ _____ Golf (Limit 36, first come, first serve) _____ $100 $125 = $ _____

Corn-Hole Tournament

Please provide player names (2 person team): (See registration desk onsite for your timeslot)

Live Auction Purchase Donation

_____ $25 _________________________

$25

= $ _____

$100

= $ _____ TOTAL = $ _____

________________________________

_____

$100

SCACS will assist you with the purchase of Live Auction item using donated cash.

My family registration fee is included in my company’s Titanium, Diamond or Emerald Sponsorship.

CHILDREN AND TEEN PROGRAM SIGN-UP

Name

Children and teens will have the opportunity to enjoy the beach and then convention. We have days and evenings planned for your children from the ages of 3-16. Please note that children must be potty trained to attend the program. Please write the name and age of all the children planning to attend programs.

1.

Security Code:

Age

2. 3. 4.

Billing Address for Card: City/State/Zip: Email for Receipt:

Make checks payable to SCACS.

Name on Card: Card #: 2016 Spring Page 10 SCACS Expiration Date:

Dietary needs: _____________________

Profile for South Carolina Association of Convenience Stores

SCACS 2016 Spring Newsletter  

Publication for Members and Prospects of the SC Convenience Stores Association and Industry

SCACS 2016 Spring Newsletter  

Publication for Members and Prospects of the SC Convenience Stores Association and Industry

Profile for scacs
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