2016 APGA Annual Conference Attendee Registration Form
2016 APGA Annual Conference Attendee Registration Form
Name:
Badge Name:
Spouse/Guest Name:
Badge Name:
Children (Names & Ages):
Company/System Name:
Address:
Contact E‐mail:
Contact Phone:
APGA Member & Spouse/Guest @ $825 Non‐Member & Spouse/Guest @ $1,225
REGISTRATION FEE:
ADDITIONAL FEES: Monday, July 25: Golf Tournament (includes box lunch & beverage cart) @ $65/person X = $
Tuesday, July 26: Spouses Program: Painting (select time & picture on reverse) @ $30/person X = $
Tuesday, July 26: Chairman’s Reception & Dinner Additional Guests Note: Reception & dinner for two is included in the registration fee. The cost for additional guests to attend the reception & dinner is $100 per person. Please indicate below: @ $100/person X = $ A child’s plate may be requested for children 12 and under at no additional charge. Number of children’s plates requested: TOTAL PAYMENT ENCLOSED: $
REGISTRATION FEE: PAYMENT OPTIONS: Please make checks payable to: American Public Gas Association or APGA. Or charge the following credit card: MasterCard Visa Amex Card Number: Exp. Date: Name on Card: Security Code: Billing Address (please provide complete address including zip code):
Please complete the reverse side of this form and check all activities you plan to attend. Incomplete registration forms will be returned.
2016 APGA Annual Conference Event Selection
Please check all activities you and your guest(s) plan to attend.
Member Spouse/ Child(ren) Guest SUNDAY, JULY 24: 5:30 p.m. Welcome Reception (International Tennis Hall of Fame – roundtrip transportation will be provided)
MONDAY, JULY 25: 7:00 a.m. Continental Breakfast 8:00 a.m. General Session 8:30 a.m. Spouses & Guests Breakfast Program 1:00 p.m. Golf Tournament ($65 per person) (Green Valley Country Club – transportation will be the responsibility of golfer)
TUESDAY, JULY 26: 7:00 a.m. Continental Breakfast 8:00 a.m. General Session 8:30 a.m. Spouses & Guests Breakfast 10:00 a.m. Spouses Program: Painting ($30 per person – limit 25 people) Please indicate preference: lighthouse or sailboat 12:00 p.m. Breakout Sessions: Please select ONE of the following: 1. Operations & Safety 2. Elected & Appointed Officials 3. R&D New Technologies w/GTI 4. Past Chairmen Networking 1:00 p.m. Spouses Program: Painting ($30 per person – limit 25 people) Please indicate preference: lighthouse or sailboat 2:00 p.m. APGA Board of Directors’ Meeting 5:00 p.m. Chairman’s Reception & Dinner
NOTE: Reception & dinner for two is included in the registration fee. The cost for additional guests is $100 per person to attend the reception & dinner. A child’s plate may be requested for children 12 and under at no additional cost.
WEDNESDAY, JULY 27: 7:00 a.m. Breakfast Buffet 7:30 a.m. APGA Research Foundation Board Meeting 9:30 a.m. APGA Annual Meeting
Thank you for your assistance by returning both pages of your completed registration form to APGA.
Send this form with payment before July 1, 2016 to: APGA | 201 Massachusetts Avenue NE, Suite C‐4 | Washington, DC 20002 Faxes will be accepted ONLY if payment is made with a credit card. Fax number: (202) 464‐0246 You may also register online at www.apga.org/newport
Questions? Please contact Sheila Deringis at (207) 415‐9414 or [email protected]
Name:
Badge Name:
Spouse/Guest Name:
Badge Name:
Children (Names & Ages):
Company/System Name:
Address:
Contact E‐mail:
Contact Phone:
APGA Member & Spouse/Guest @ $825 Non‐Member & Spouse/Guest @ $1,225
REGISTRATION FEE:
ADDITIONAL FEES: Monday, July 25: Golf Tournament (includes box lunch & beverage cart) @ $65/person X = $
Tuesday, July 26: Spouses Program: Painting (select time & picture on reverse) @ $30/person X = $
Tuesday, July 26: Chairman’s Reception & Dinner Additional Guests Note: Reception & dinner for two is included in the registration fee. The cost for additional guests to attend the reception & dinner is $100 per person. Please indicate below: @ $100/person X = $ A child’s plate may be requested for children 12 and under at no additional charge. Number of children’s plates requested: TOTAL PAYMENT ENCLOSED: $
REGISTRATION FEE: PAYMENT OPTIONS: Please make checks payable to: American Public Gas Association or APGA. Or charge the following credit card: MasterCard Visa Amex Card Number: Exp. Date: Name on Card: Security Code: Billing Address (please provide complete address including zip code):
Please complete the reverse side of this form and check all activities you plan to attend. Incomplete registration forms will be returned.
2016 APGA Annual Conference Event Selection
Please check all activities you and your guest(s) plan to attend.
Member Spouse/ Child(ren) Guest SUNDAY, JULY 24: 5:30 p.m. Welcome Reception (International Tennis Hall of Fame – roundtrip transportation will be provided)
MONDAY, JULY 25: 7:00 a.m. Continental Breakfast 8:00 a.m. General Session 8:30 a.m. Spouses & Guests Breakfast Program 1:00 p.m. Golf Tournament ($65 per person) (Green Valley Country Club – transportation will be the responsibility of golfer)
TUESDAY, JULY 26: 7:00 a.m. Continental Breakfast 8:00 a.m. General Session 8:30 a.m. Spouses & Guests Breakfast 10:00 a.m. Spouses Program: Painting ($30 per person – limit 25 people) Please indicate preference: lighthouse or sailboat 12:00 p.m. Breakout Sessions: Please select ONE of the following: 1. Operations & Safety 2. Elected & Appointed Officials 3. R&D New Technologies w/GTI 4. Past Chairmen Networking 1:00 p.m. Spouses Program: Painting ($30 per person – limit 25 people) Please indicate preference: lighthouse or sailboat 2:00 p.m. APGA Board of Directors’ Meeting 5:00 p.m. Chairman’s Reception & Dinner
NOTE: Reception & dinner for two is included in the registration fee. The cost for additional guests is $100 per person to attend the reception & dinner. A child’s plate may be requested for children 12 and under at no additional cost.
WEDNESDAY, JULY 27: 7:00 a.m. Breakfast Buffet 7:30 a.m. APGA Research Foundation Board Meeting 9:30 a.m. APGA Annual Meeting
Thank you for your assistance by returning both pages of your completed registration form to APGA.
Send this form with payment before July 1, 2016 to: APGA | 201 Massachusetts Avenue NE, Suite C‐4 | Washington, DC 20002 Faxes will be accepted ONLY if payment is made with a credit card. Fax number: (202) 464‐0246 You may also register online at www.apga.org/newport
Questions? Please contact Sheila Deringis at (207) 415‐9414 or [email protected]
