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Secure Online Registration

PLEASE COMPLETE THIS REGISTRATION FORM
BY DECEMBER 1ST, 2006

Questions?? If you experience any difficulties or require additional information we can be reached at:
Tel: 1-877-339-3989 or 1-416-593-5488  Fax: 1-416-593-1805  
e-mail: acme@andlogistix.com

 

ACME Inc. will pay your overnight accommodations during the three day conference, January 7 - 9th, 2002. All other room charges (such as telephone calls, room service, valet, etc.) will be billed to your personal credit card, an imprint of which will be taken when you check-in. You are responsible for settling all hotel incidental charges upon checkout.

Hotel check-in is 4:00 p.m.. Rooms may be available prior to 4:00 p.m. based on availability. Hotel checkout is 12:00 Noon on Wednesday. Should you require a late checkout, please make the necessary arrangements at the time of check-in.

PARTICIPANT NAME:

FIRST NAME * MIDDLE NAME LAST NAME
*
NAMEBADGE:
 (as you would like it to appear on your nametag)
FIRST NAME
LAST NAME
 		TITLE
*
ORGANIZATION:
*
MAILING ADDRESS:
(Cannot deliver to P.O. box)
MAILING ADDRESS
 *
CITY
 *
STATE/PROV
 *
ZIP/POSTCODE
 * 		COUNTRY
 *
 
EMAIL ADDRESS
 *
HOME PHONE
 BUSINESS PHONE
 
 BUSINESS FAX
 
DIETARY / SPECIAL NEEDS:
PLEASE LIST ANY SPECIAL DIETARY/HEALTH REQUIREMENTS
EMERGENCY CONTACT:
CONTACT NAME
RELATIONSHIP
 		PHONE
HOTEL INFORMATION:
Attending, however, no accommodations are required
 
CHECKIN DATE (mm/dd)
CHECKOUT DATE (mm/dd)
 		 SMOKING
  Yes
PRE-POST CONFERENCE ACCOMMODATIONS: Las Vegas resort is offering the conference rate of $169 per night - based on availability. Click here for more about Las Vegas Resort.

AIR TRAVEL

  
BOOKING:

I would like ACME Inc. office to contact me with a tentative travel itinerary based on the information I have provided. (One of our American Express agents will contact you by email within 48 hours of your registration.)

I will book my own flights and provide that information to ACME Inc.. Please Email your flight information to Kristin Sullivan at staff@Acme.com no later than December 14th, 2002.
 
AIR INFORMATION:
DEPARTING CITY
AIRPORT
 		DATE
 		TIME
PREFERRED AIRLINE AND FREQUENT FLYER NUMBER
RETURNING DATE
 		 TIME
 		 FROM Las Vegas TO
 
 
GROUND TRANSPORTATION:

Ground transportation will be provided from the Las Vegas airport to the Resort if we have your flight information by December 14th, 2002.
I require an airport transfer.

No transfer required.

ACTIVITIES:
WEDNESDAY
Golf Tournament
Horseback Riding
Desert Jeep Tour
No Activity
SHIRT SIZE:
Men's Ladies
Small  Medium  Large   Extra Large  Extra-extra Large
CREDIT CARD:
(required for hotel incidental charges)
Credit Card Number:
   *
Credit Card Type:
   *   Click here for more details
Expiration Date:
   *  *
Card Holder's Name:
   *
 

 

For further information about this event we can be reached at:
Tel: 1-877-339-3989 or 1-416-593-5488  
Fax: 1-416-593-1805  
E-mail:acmeinc@andlogistix.com

  

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