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2009 Convention Registration Form

Complete this registration form for each person registering. If you prefer to mail in your payment, please complete and return the printable version of this form.

Please fill out and return a separate form for each attendee. Asterisks beside the field name indicates a required field.

 1. Registration Type
Delegate:
Other Pilot:

Early Registration Fees:
Before June 1: $.00 
(includes 2 Banquets & 1 Luncheon)
  After June 1: $. 
Co-Pilot: (includes 1 breakfast & 2 Banquets)
Non-Pilot:

Early Registration Fees:
Before June 1: Co-Pilot-$160.00 
(includes 2 Banquets & 1 Breakfast)
  After June 1: -$240.00 
Before June 1: Non-Pilot-$.00 
(includes 2 Banquets & 1 Breakfast)
  After June 1: $.00 
Anchor:
   

Early Registration Fees:
Before June 1: $.00 
(includes 2 Banquets and 2 lunches)
 After June 1: $  

If you choose to obtain lodging at a hotel other than the convention hotel ( ), please add $25.00 to each registration fee. Our complimentary meeting space is based on number of Pilot rooms sold at convention hotel.

Checks should be made payable to Pilot International or Credit Card information must accompany registration.

Hotel reservations must be made directly with the hotel. (See link to Hotel Reservations on the Pilot International Web site).

Registrations must be received no later than June 1, 2009.

Are you staying at the convention hotel? Yes No
 2. Personal Information
Registration fee, less 25% handling charge, will be refunded
if written cancellation is received by June 1.

     
   *First Name:   *Last Name:   Nickname: (for Badge)                  Email
     
   *Address   *City *State/Province         *Zip             *Country
  Is this your first Pilot convention? Yes
No
   *Phone   Fax
   
   Anchor/Pilot Club   District Name of Pilot member with whom
you are attending convention:

 
 In compliance with ADA legislation, do you need special assistance?
When will you be arriving? July 
July 
July 
 
 3. Service Details and Payment Infomation
 I've been a member of Pilot since: (yr)
Please tell us your 2008-2009 office
 Please list your occupation or position?
 
Club: President Club PIF Rep

 Select from the list below the convention  committee on which you would like to serve:

 
District: Govenor Governor Elect
  Lt. Govenor
  Secretary Treasurer
Credit Card Information PI/District Coordinator:    
*Name on Card:   Club Operations Projects
*Credit Card #   Fund Raising: Anchor
*Exp.Date: mmyy
   

 

 
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