Office Use Only Date In_ _________________ Amount In_ ______________ Confirm__________________ 2022 Convention Registration March 25 - 30, 2022 Fairmont Scottsdale Princess Scottsdale, Arizona 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 Fees All attendees must be registered Questions? (703) 212-7745 Room Type p Fairmont Room $369 | p Fairmont Deluxe Room $399 | p Sunset Signature Room $409 | p Casita Jr. Suite $429 p Casita Suite $569 | p Sunset Beach Corner Suite $569 | p Master Suite $1,099 Bed Type p King Bed p 2 Queen Beds Room rates are subject to taxes and service charge. Early departures will result in an early departure fee equal to 1 night’s room rate. 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 4th Annual Associates Exhibit APCA Payment must accompany this registration in the form of a check or credit card. Payment must be received by February 15, 2022, 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 Registration Category By 2/15/22 After 2/15/22 Subtotal Owner/Employee Member $1195 $1495 Spouse/Guest $695 $795 Youth 5-10 $345 $445 Youth 11-18 $495 $595 Optional Activities Please enter registrant’s number (1-4) from above Fees Registrant # ATV Excursion (Sat, 12:45 - 5 pm ) $375 TaliesinWest Tour (Sat, 1:30 - 4 pm) $125 High Speed Kart Racing (Sun, 1- 5 pm) $205 APCA Golf Tournament (Mon, 12:30 - 6:30 pm) $330 Golf Club Rental (Mon) p Mens p Womens | p Right p Left $87 Interactive Culinary Journey (Mon, 1 - 3pm) $200 Spouse Breakfast (Tues, 9 - 10:30 am) included Hummer &Wine Tasting (Tues, 1 - 5:30 pm) $475 Old Town Scottsdale Seqway Tour (Tues, 1 - 5 pm) $250 Total Fees Registration Info • Email this registration form to registration@ americanpipeline.org OR • Mail this registration form with payment to: PO Box 638 Churchton, MD 20733 Cancellation Policy There is no charge for cancellations received before 1/31/22. After 1/31/22 and before 2/28/22 there will be a 50% cancellation charge. There will be no refunds after 2/28/22.