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: state/Province: Country: office Phone: Fax: r E gistrAtio n Email: Chapter: Shore Dec. 25 - 29, 2013 Harbor Beach Marriott Fort Lauderdale, FL Harbor Beach Marriott $179 per night rate is available only for convention registrants and their families. rEgistrAtion FEEs For ConvEntion AnD CruisE Members must be in good standing prior to start of convention. Harbor Beach Marriott Convention* option 1 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 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 ............. $_____________ $_____________ $_____________ $_____________ $_____________ $_____________ 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) Alpha omega * 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. PAyMEnt Please Charge My: name on Credit Card: Card number: signature: Expiration Date: total Amount: Cvv: visA MasterCard American Express 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. I Authorize a deduction from my Credit Card for Full Payment. 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 http://ao.org/events/2013-convention 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 you may still be able to book a cabin in our group block but the pricing may be different. Please contact Jodi Murphy immediately. www.ao.org Contact Jodi directly at 610/399-4501 to book your cabin. o m e g a | a o n o w 3 a l p h a