REGISTRATION FORM

"Getting the Most from Your ESOP"

Illinois Chapter Winter Conference

Thursday, March 6, 2014

iHotel & Conference Center
1900 South First Street • Champaign, IL 61820 • 217-819-5000

www.stayatthei.com

Members must login to the website to receive the member price.
  On/before Tuesday, February 25, 2014  After Tuesday, February 25, 2014
Members:  $125.00 (1st registrant)
$110.00 (2nd registrant)
$110.00 (3rd or more registrants)
$140.00 (1st registrant)
$125.00 (2nd registrant)
$125.00 (3rd or more registrants)
     
Non Members:  $175.00 (per registrant)
$200.00 (per registrant)
     

Above fees include the Pre-Conference Social on Wednesday evening, March 5.

*Please Indicate Number of Persons for Each Registration Category.

Members:
Non Members:

Total number of Registrants : Total:

Registrant 1

Prefix:
First Name: Last Name:
Title: Email:

Registrant 2

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First Name: Last Name:
Title: Email:

Registrant 3

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First Name: Last Name:
Title: Email:


Registrant 4

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First Name: Last Name:
Title: Email:


Registrant 5

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First Name: Last Name:
Title: Email:


Registrant 6

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First Name: Last Name:
Title: Email:

Registrant 7

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First Name: Last Name:
Title: Email:

Registrant 8

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First Name: Last Name:
Title: Email:


Registrant 9

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Title: Email:


Registrant 10

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First Name: Last Name:
Title: Email:



Company Information

Company Name:
Company Contact First Name:
Company Contact Last Name:
Address:
Address Line 2:
City:
State:
Zip:
Phone:
Country :
Fax:
Email:

Order Total:

* Name On Credit Card:  
Credit Card:
* Card Number:  
* Security Code:

Expiration Date:


Your credit card will be charged the amount of : .



* Required Field
‡ The maximum amount of registants per request is 10.
Cancellation Deadline: February 25, 2014. You may send a substitute at no additional charge.

iHotel Room Reservation Information Special Group on Wednesday, March 5 and Thursday, March 6 $129 (double)
Reserve online at: www. stayatthei.com
Select the orange 'Attendee Code' button and enter: AILESOP
Hotel Reservation Deadline: February 12, 2014