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FLORIDA’S
VOICE ON MENTAL RETARDATION
Statewide
Conference
October 15, 2005
Registration Form
Please PRINT, FILL OUT and MAIL
| Name: |
____________________________________________________________________ |
| Address: |
____________________________________________________________________
____________________________________________________________________
|
| Telephone: |
____________________________________________________________________
|
| Email: |
____________________________________________________________________
|
| |
FEES
(Check appropriate blank) |
|
__________
|
FVMR
Member |
$25.00 |
| __________ |
Individual/Family
(non-FVMR member) |
$35.00 |
| __________ |
Association/Agency/Company
(FVMR Member) |
$75.00 |
| __________ |
Association/Agency/Company
(non-FVMR Member) |
$100.00
(2 guests,
$75.00 for each
additional guest) |
| __________ |
Exhibitor
Space |
$ 175.00
(FVMR member &
Non-FVMR members)
(Only 8 spaces -
“First come, first served”.) |
Please make
your check payable to “FVMR”
and send it in with this Registration form to:
FVMR
c/o Arlene Lakin, Esq.
5591 N.E. 28th Avenue
Ft. Lauderdale, Florida 33308
Questions, incl. financial inability to pay?
Call (954) 975-5159 - or email - FVMRorg@aol.com
Hotel Reservations:
(954) 772-5400
The Sheraton Suites Cypress Creek Hotel is located at:
555 N.W. 62nd Street
(Cypress Creek Road & I-95)
in Fort Lauderdale.
Special FVMR room rate is $ 90.00.
Florida's
Voice on Mental Retardation, Inc.*
5591 N. E. 28th
Avenue
Fort Lauderdale,
Florida 33308
(954) 975-5159
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