2014 CONFERENCE REGISTRATION FORM

2014 CONFERENCE REGISTRATION FORM Please print clearly or type. Submit a separate form for each full conference registrant.

 Non-member

 EWGA Member #:________________ Chapter Affiliation: ______________________________

 First Time Attendee? Last Name:________________________________________ First Name:___________________________________ Company Name: ___________________________________ Job Title: ___________________________________ Handicap Source (EWGA, GHIN, etc.) ___________________ or average score for 18 holes ___________________ Handicap Identification # _________________________________________________________________________ Primary Phone:____________________________ email: _______________________________________________ Address:___________________________________City:__________________________________State:_________ Country ______________________________ Arrival Date: _________________ Departure Date: ____________

Please check appropriate boxes below, then add totals in far right column Early Registration (Closed) Registration

Select appropriate category:  Executive Distinction Member  EWGA Member  Nonmember

By 3/31 $635 $685 $815

Volunteer Leader Summit Registration

Yes, I will attend the Volunteer Leader Summit:  EWGA Volunteer Chapter Leader Main Role (Nat’l/Chapter):____________________  Interested in becoming an EWGA Chapter Leader

No cost

Weds. April 9, 2014 8:00 a.m. – 4:00 p.m.

Conference Registration Totals: Golf Activities for Full Conference Attendees

Full Conference Registration Fee:

$

(included with full conference registration):

Select One Tuesday, April 8 golf event from these options:

 Track 1 – New Golfers

 Track 2 – Intermediate

 Track 3 – Advanced

 Track 4 – Traditional

New Golfer On Course Golf Exp.

2 Person Scramble

Four Ball Matches

2 Person Best Ball / Team Challenge

Mission Possible

Salsa Scramble

Rodeo Roundup

Santa Anna’s Assault

Empower ’14 – An EWGA Experience Registration Form ~ Page 1 of 2

Please check appropriate boxes below, then add totals in far right column Optional Events / Add-ons (at additional cost):

Choose between (select one):

Sunday, April 6

Morning Golf at La Cantera Hill Country Resort  Track 2 (Intermediate) The Alamo – Palmer Course  Track 3 (Advanced) The Riverwalk –Resort Course

Optional Golf Events Players responsible for transportation to/from golf courses Track Track Track Track Track

1 2 3 4 5

@ @ @ @ @

$110.00 $105.00 $105.00 $140.00 $105.00

pp pp pp pp pp

– – – – –

1:00 8:00 8:00 1:00 1:30

PM (La Cantera Academy) AM Shotgun (Palmer Course) AM Shotgun (Resort Course) PM Shotgun (The Dominion) PM Shotgun (Resort Course)

Afternoon Golf at La Cantera Hill Country Resort  Track 1 (New Golfer) Cowgirls Come Home –The Academy  Track 5 (Advanced)The Riverwalk –Resort Course Afternoon Golf at The Dominion Country Club  Track 4 (2 person Team Play) Across the Border (includes buffet lunch at 11:45 AM prior to start of play)

Please pair me with (if applicable):

Guest Info (if applicable):

Two-Person Team Play Partner

1.

Full Name: ________________________________________

__________________________

Registration Totals

Guest HDCP Index or Avg. Score for 18 holes: __________

(Full Conference Attendee):

Sunday Optional Golf Subtotal

$ __________

à la carte options for local chapter members and non-members: Sunday, April 6 Welcome Reception & Dinner @ $135 per person

 EWGA Empower ‘14 Welcome Reception, Dinner & Entertainment

Monday, April 7: Monday Daily Conference Fee @ $285 per person

 Teeing Up for Success Monday Conference Activities

Tuesday, April 8: Tuesday Daily Conference Fee @ $300 per person

 Tee it Up Tuesday Conference Golf Day, Big Break & Dinner

Tuesday, April 8: Tuesday Evening Dinner Fee @ $135 per person

 EWGA’s Got Talent Reception & Dinner Celebration

Total optional golf / add-ons:

à la carte fee à la carte fee

$ ________

à la carte fee

$ ________

à la carte fee

$__________

Method of Payment:  Check enclosed

$ __________

$ ________

Total Conference Fees encl.

$__________

 Charge my credit/debit card the full amount

Please Print Name as it appears on Card _______________________________________________________________ Billing Address ___________________________________________________________________________________ _______________________________________________________________________________________________ Cardholder Signature_______________________________________________________________________________ (Submission of this application constitutes acceptance of the EWGA Release and Indemnification Agreement found on www.ewga.com/release)

Credit or debit card to be used:  American Express

 MasterCard/Visa

 Discover

Exp.(MM/YY) ____/_____

Credit Card Number ___________________________________________________________ Security Code _______ To make room reservations at La Cantera Hill Country Resort at the special EWGA rate, call (210) 558-6500. Be sure to mention EWGA when making your reservations to receive the special EWGA rate. Conference Registration Deadline: March 31, 2014. Submit completed form by fax (561) 691-0012, email: [email protected] or mail to EWGA Headquarters at: 300 Avenue of the Champions, Suite #140, Palm Beach Gardens, FL 33418-3615.

Empower ’14 – An EWGA Experience Registration Form ~ Page 2 of 2