REGISTRATION FORM


2015 SUPER REGIONAL BOARD OF DIRECTORS & TRUSTEE CONFERENCE

Tuesday, June 9, 2015 - Wednesday, June 10, 2015

New England, NY/NJ, and PA/DE Chapters (Rochester, NY)

MARRIOTT AIRPORT HOTEL, 1890 Ridge Road West, Rochester, NY 55902

Members must login to the website to receive the member price.
  Final Registration Deadline Wednesday, June 3, 2015 
Members:  $295.00 (1st & 2 nd Attendees per company)
$255.00 (3rd or more Attendees per company)
     
Non Members:  $575.00 (Each Attendee)
     
*Please Indicate Number of Persons for Each Registration Category.

Members:
Non Members:

Total number of Registrants : Total:

Registrant 1

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First Name: Last Name:
Title: Email:

Registrant 2

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Title: Email:

Registrant 3

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First Name: Last Name:
Title: Email:

Registrant 4

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Registrant 5

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Registrant 6

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Registrant 7

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Registrant 8

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Registrant 9

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Registrant 10

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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:


Dinner Only Guest –Tuesday Evening $95.00 each. Qty of Tickets : $
Your credit card will be charged the amount of : .



* Required Field
‡ The maximum amount of registants per request is 10.

You may send a substitute from your company at no additional charge.

Hotel Information:

A block of rooms is being held for this event. Room rate: $149/night + tax. Reservation deadline: May 24th.

Call 866.237.5979 to make your reservation. Please request “The ESOP Assoc. Conference Rate”.