Florida's Voice on Mental Retardation
October Conference Registration Form
 

(We accept payment by credit card or check through Paypal.
You may also send us a check through the US mail.
Payment instructions will be given when you submit the form below.)


 
Name:
Association Name:
Address:
City:
State:
Zipcode:
Home Phone:
Work Phone:
FAX:
E-mail:
Registration Fees:
FVMR Member (Individual or Family):
$25
Non-FVMR Member (Individual or Family):
$35
Association/Agency/Company (FVMR Member) :
 $75
Association/Agency/Company (non-FVMR Member):
$100 (2 guests, $75.00 for each additional guest)
Exhibitor Space:
$175 (Only 8 spaces - First Come First Served)
Additional comments:

Make all checks payable to:

FVMR
c/o Arlene Lakin, Esq.
5591 N.E. 28th Avenue
Ft. Lauderdale, Florida 33308

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Updated: 04-14-04