A c t L o c A L Ly – t h i n k G L o b A L Ly U LT I M AT E AO SHORE TO SHIP cOnvEnTIOn SHORE TO SHIP REgISTRATIOn FORM name: Spouse’s name: Home Address: city: Zip/Postal code: Home Phone: cell Phone: Email: R E gISTRATIO n State/Province: country: Office Phone: Fax: chapter: Shore Dec. 25 - 29, 2013 Harbor Beach Marriott Fort Lauderdale, FL REgISTRATIOn FEES FOR cOnvEnTIOn AnD cRUISE Members must be in good standing prior to start of convention. Harbor Beach Marriott convention* opTioN 1 Frater and Spouse Frater Only young Alum, or Recent grad & Spouse cE Program Only Frater young Alum, or Recent grad Only Student Frater, young Alum, or Recent grad (Spouse, Family Members, Students gRATIS) $900.00* US ............ $500.00* US ............. $750.00* US.............. $425.00 US............... $375.00* US .............. $350.00* US ............. $_____________ $_____________ $_____________ $_____________ $_____________ $_____________ Ship Dec. 29, 2013 - Jan. 5, 2014 Holland America Eurodam Port Everglades, FL PLEASE RETURn THIS FORM TO: International Dental Fraternity 2013 convention 50 W. Edmonston Drive Suite 303 Rockville, MD 20852 cruise Only convention* opTioN 2 $300.00* US ............. $_____________ pACkAge DeAl opTioN 3 Harbor Beach convention and cruise* Frater and Spouse $1,100.00* US ........... $_____________ young Alum, or Recent grad & Spouse $1,000.00* US .......... $_____________ Frater, young Alum, or Recent grad Only $700.00* US ............. $_____________ Student (gRATIS) * Includes: 2 dinners (Shabbat and Honors Night), 2 breakfasts (Welcome and Farewell), and Spouse luncheon. Hotel Rate of $179 Per Night. A limited number of rooms are available 3 days before and 3 days after the convention, based upon availability. PORT cHARgES, TAXES, AnD gRATUITIES IncLUDED. Alpha Omega PAyMEnT Please charge My: name on credit card: card number: Signature: vISA Mastercard American Express Expiration Date: Total Amount: cvv: P: 301/738-6400 | TF: 877/368-6326 F: 301/738-6403 www.ao.org note: There will be a $150 Administrative Fee for cancellations after December 1, 2013. All Payment Plans Must be completed by December 1, 2013. I Authorize a deduction from my Credit Card for Full Payment. I Authorize Quarterly deductions from my Credit Card* Payments will be made on 3/1/13, 6/1/13, 9/1/13, & 12/1/13 * If a payment date is missed, it will be processed in the upcoming quarter. Sharon Perlmutter, Convention Marshal Alan Moltz, Convention Representative David Schneider, Treasurer Enclosed please find a check payable to: Alpha Omega International Dental Fraternity 50 W. Edmonston Drive, Suite 303 | Rockville, MD 20852 Full Payment Quarterly Payments http://ao.org/events/2013-convention cRUISE PRIcIng FOR ADULTS AnD cHILDREn Fraters must register for the cruise through Jodi Murphy, Cruise and Travel Partners. Jodi has reserved a block of cabins for Alpha Omega and will include incentives to AO for booking. This cruise is open to the public so it is recommended that you reserve your cabin now. Cruise prices are for adults and children. *Please call Jodi for pricing to add a 3rd and/or 4th person to the cabin. Jodi Murphy Cruise and Travel Partners, Inc. 912 Adams Way • West Chester, PA 19382 Tel: 610/399-4501 • Cell: 610/420-9364 www.cruiseandtravelpartners.com Email: cruiseandtravelpartners@comcast.net contact Jodi directly at 610/399-4501 to book your cabin. www.ao.org Interior ............... $1,499pp Oceanview ....... $1,759pp (picture window) Verandah ............ $1,949pp Suite ................... $2,799pp number of people ________ a l p h a o m e g a | a o n o w 6