Convention Registration Form

Westport, CT. Oct. 12, 13, 14 - 2012

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Fill in the blanks ONE REGISTRATION FORM PER PERSON must be 18 years or older

Name:

E-Mail:

Address:

City

State

Zip

Home Phone:

Cell Phone:

USERNAME:
(Fowl House or Message Board):

Arrival Date:       Time of Arrival:
Arriving: Car       Plane      Bus
Airport      Airline      Flight # and Time
I plan to stay overnight:   Thursday      Friday        Saturday        Sunday
Room Details:   Single Occupancy      Double Occupancy     King Bed   Two Queen Beds
.Smoking      Non-Smoking
Roommate's Name:
Comments:

$10.00 per person. Registration postmarked prior to October 7, 2012.
(non member add $10.00 for membership dues)

$15.00 per person Registration postmarked on or after October 7, 2012.
(non member add $10.00 for membership dues)

Registration Ends 10-13-12.

Please be mindful that GFBA members may not want their photos uploaded to the internet and tagged on Facebook or any other web page. Please get each member permission.

I agree to respect peoples’ privacy who do not want to be identified on the internet.

Signature: ________________________________________________________

1. Send this registration form by snail-mail, fax, or email. PRINT THIS FORM
2. Send Check or Money Order via snail-mail or send money via PayPal.
3. Confirmation will be sent to you via email.

PayPal Link:

Check or Money Order:

payable to GFBA

Snail Mail Address:

Fax Number: 203-312-1058

Phone Number: 203-858-8782

E-mail: phyllis@gfba.org

. G.F.B.A. | AGENDA | ACCOMODATIONS | REGISTRATION FORM