EASTERN 2006
RECEPTION TABLE FORM
DECEMBER 27 – 30, 2006, MARRIOTT WARDMAN PARK, WASHINGTON, D. C.
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 Marriott Ballroom on December 28th (8:00 p.m. to midnight) and in the Marriott Ballroom on December 29th (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. 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. The deadline for receipt of reservations is December 5th. After that time we will still take reservations but your school’s name will not appear in the handout.
Name:_________________________________________________________________
School/Organization:_____________________________________________________
E-mail address: ________________________________________________________
Please select an option for payment and fill out the form completely if paying by credit card.
___ 1) Check* (Payable to APA)
*The APA can only accept checks drawn on a U.S. bank, in U.S. Dollars.
___ 2) Visa MasterCard Exp. Date
Last 3 digits on back of card
Name as it appears on Card:
Signature of Authorization:
Email: Phone #: