APCA 2019 Convention

Office Use Only Date In_ _________________ Amount In_ ______________ Confirm__________________ 2019 Convention Registration March 29 - April 3, 2019 Ocean Reef Club Key Largo, Florida Registrant Information Register no more than one couple per page 1. Registrant’s Name Badge Name 2. Spouse/Guest Name Badge Name 3. Youth 1 Name Age Badge Name 4. Youth 2 Name Age Badge Name Company Title Street Address City State ZIP Phone Cell Email Registration Info • To register online go to: www.americanpipeline.org • Fax this registration form to (703) 548-3733 • Mail this registration form with payment to: 1908 Mt. Vernon Ave. 2 nd Floor Alexandria, VA 22301 Registration Fees All attendees must be registered Registration Category By 1/31/19 After 1/31/19 Subtotal Owner/Employee Member $1195 $1495 Spouse/Adult Guest $695 $795 Youth under 10 $0 $0 Youth 11-18 $495 $595 Optional Activities Please enter registrant’s number (1-4) from above Fees Registrant # Spouse Breakfast (Tuesday) included APCA Golf Tournament (Monday) $360 Golf Club Rental p Mens p Womens | p Right p Left $100 Group Snorkeling Trip (Saturday) $95 Powerboat Poker Run (Tuesday) $450 Private Eco-Kayak Tour (Tuesday) $85 Total Fees Cancellation Policy There is no charge for cancellations received before 1/31/19. After that date, no refunds will be given. Please confirm cancellation and refund request in writing. Questions? Call us at (703) 212-7745 Room Type p Deluxe Tropical View Room $329 | p Prem. Tropical View Room $359 p Yachtsman Inn Room $389 | p Prem. Water View Room $409 | p Prem. Ocean View Room $429 p Two Bedroom Villa $739 | p King Beg p Two Queen Beds | p Road Cart Rental Hotel Registration Credit card is required to reserve rooms. This is a separately charged item . Card Type: p MasterCard p VISA p AMEX Credit Card Number Expiration V-code Cardholder Name Signature Check-in Date Check-out Date Exhibit p Yes, I Want a Tabletop at the 2 nd Annual Associates Exhibit APCA Payment must accompany this registration in the form of a check or credit card. Payment must be received by January 31, 2019, for early discount. p Check Please make payable to APCA p MasterCard p VISA p AMEX Credit Card Number Expiration V-code Cardholder Name Signature Credit Card Billing Address p I’m a First-time Convention Attendee

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