2014 G. & C.I.C.A. 

 CONVENTION REGISTRATION FORM

Winchester, Virginia

May 8th, 9th, 10th, & 11th,   2014

Best Western Lee Jackson Inn and Conference Center

711 Millwood Avenue, Winchester, Virginia 

(540) 662-4154, be sure to ask for "Group Registration--G&CICA"

Hotel reservations may be made as late as May 1, 2014 at this special rate,

However if you are selling in your room, reserve early and request a first Floor Room

Room rates are $82.50, this includes taxes and applies to your entire stay

Daily Coupons for $2.50 will be issued for Breakfast at the Restaurant

  

PLEASE REGISTER EARLY

Complete REGISTRATION FORM fully !

COMPLETED FORM TO ARRIVE NO LATER THAN April 1st 2014 TO THE ADDRESS SHOWN ON BACK

No cancellations after April 1st, 2014

Only reservations received by January 1, 2014 will be Guaranteed a Commemorative piece

 

Name of Participant No. 1:___________________________________________________________________________________________

Name for name badge:  _____________________________________________________________________________________________

Name of Participant No. 2:___________________________________________________________________________________________

Name for name badge: ______________________________________________________________________________________________

Address: _______________________________________________             Phone _________________or_______________

City_______________________ State: _______ Zip________                     Email___________________________________

Emergency Contact Person: _____________________________________   Phone__________________or_______________

Will you be selling in your room?           Yes ______ No_____

Is this your first G&CICA Convention?  Yes ______ No_____

 

 

--Fill out back also--

 

 

 

CONVENTION REGISTRATION FEES

 

Number attending convention     ________ @ $115.00 each        = $ ________

Number of tables for Swap Meet  _______ @   $15.00 each        = $ ________

 

Persons attending the Thursday function at the Museum of

The Shenandoah Valley from 2 – 7 pm transportation included

We need 50 persons by March 1st, full refund if cancelled.

                                                         _______ @ $45.00 each     = $ ________

                                                              

                                                                TOTAL ENCLOSED =  $_________

 

Make checks payable to “2014 GRISWOLD CONVENTION”

Mail check with this completed form no later than March 1, 2014 to:

Lee C. Dieter, 3176 Liberty Furnace Road, Edinburg, VA   22824

If you have questions email  lcdieter@shentel.net   Dieter Home         (540) 984-3907 

A “Hospitality” room will be set up at the hotel on May 9th and 10thsnacks; soft drinks and beer “no charge”
Donations accepted.

For hosts’ planning purposes, please indicate below if you plan to attend Saturday’s convention banquet buffet       (Cash bar available.)

 

Attending Banquet ________Yes, I/we will attend. 

No, I/we will not attend the banquet __________

 

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Don’t write beyond here.  Convention Registration Use Only:

 

Date Rec’d ___________Audited_____ Check #__________Date Dep._______Confirm___________