| Name __________________________________________________________ |
CMB # ________ |
Spouse or Guest Name(s) _____________________________________________________________ |
Address ___________________________________________________________________________ |
City _______________________________________________________State _______Zip _________ |
Phone: ____-_______-_______Email: __________________________@ _______________________ |
First 2 tables included with registration, additional tables at $10.00/table.
Table covering and skirting are required
Stanchions will be provided for displays in the open mall area.
Number of tables requested ________ Do you require an electrical outlet? Yes [ ] or No [ ]
Prefer to display in open mall area [ ] Prefer to display in vacant store space [ ]
Can display in either area [ ]
Registration |
Convention Registration (Includes 1 Banquet Ticket) |
____ @ $65.00 |
$ ______.00 |
Additional Tables |
____ @ $10.00 |
$ ______.00 |
Vendor Registration |
____ @ $25.00 |
$ ______.00 |
Additional Banquet Tickets |
____ @ $30.00 |
$ ______.00 |
Ladies Luncheon Tickets (Fri @ 11:00) |
____ @ $15.00 |
$ ______.00 |
Optional-Trip to Selby Botanical Gardens (Fri @ 1:00) |
____ @ $15.00 |
$ ______.00 |
Late Registration (After March 15th) |
____ @ $25.00 |
$ ______.00 |
|
Total |
$ ______.00 |
Make Check Payable to: L.R. Smout-Circus Model Builders
Mail to Kathy Beurlen
766 Lighthouse Dr.
Tarpon Springs, FL 34689-1801
727-942-6359
CIRCUSDAY@earthlink.net
All registrations must be mailed by March 15, 2010
Late fee of $25.00 after March 15th |
