CENTRAL 2008
RECEPTION TABLE FORM
APRIL 16-19, 2008, THE PALMER HOUSE HILTON, CHICAGO, IL
Fax this form with your credit card payment to Linda Smallbrook (302-831-3372). No cover sheet is needed. Or, if you prefer, mail this form with your payment to Linda Smallbrook, APA, University of Delaware, Newark, DE 19716.
Payment must accompany your registration form.
IMPORTANT NOTE: DUE TO POLICY CHANGES WITHIN THE APA, ALL TABLE RESERVATIONS MUST BE PAID FOR AT THE TIME OF PLACING THE RESERVATION. WE WILL BE UNABLE TO PROCESS YOUR FORM WITHOUT THE ACCOMPANYING PAYMENT. THANK YOU FOR YOUR UNDERSTANDING.
Receptions are scheduled to be held in the Red Lacquer Room on April 17th (8:30 p.m. to midnight) and in the Red Lacquer Room on April 18th (9:00 p.m. to midnight). The first night reception provides beer and soft drinks at no charge. Admittance is by registration name badge or ticket only. The second night reception is a cash bar. The charge for a table at both receptions is $25.00 total. The deadline for receipt of reservations is April 1st. After that time we will still take reservations but your school’s name will not appear in the handout.
To reserve a table, please complete the following and return to Linda Smallbrook, APA, University of Delaware, Newark, DE 19716; or fax the form to 302-831-3372.
Name:_________________________________________________________________
School/Organization:_____________________________________________________
E-mail address: ________________________________________________________
Please select an option for payment and fill out the form completely if paying by credit card
.Visa____
MasterCard____
Amex ____ Diner’s
Club____
Discover____
Exp. Date ________
____ ____ ____ ____ -- ____ ____ ____ ____ -- ____ ____ ____ ____ -- ____ ____
____ ____
Name as it appears on Card: _____________________________________
Signature of Authorization: _____________________________________
Email: _____________________________________ Phone #:_____________________________________