Registration
Updated 4-26-2006
Attention Registration form 10.3 is the latest. All other version has been recalled and are no longer valid. The Lunch price has been changed from $20.00 to $23.00. The Hotel had a price change on the Lunch Plate. We will now be serving a chicken plate.
Early Bird Dated before May 31, 2006
A USS Midway Tour may be available at the convention on Saturday. You will be picked up at the Hotel and brought back by bus. The cost for the bus and the admission is $20.00. Tickets will be available at the door. If you think you might attend this tour, please e-mail me at kc6qls@cox.net and in the subject line put "USS Midway Tour". If the bus capacity is not reached, the Tour will be cancelled.
Form in Word
File in PDF
You will need 
| Radio | Web Search | Ham Club | News Paper | Other _____________ |
Registration Form
Please list additional Attendees – ALL ATTENDEES MUST BE REGISTERED
No charge for Children 16 or under when Accompanied by a Registered
Adult
Call Sign:_________________ Last Name:__________________
First Name:_______________
Address: _________________________________ City __________________________
State: __________________ Zip Code: _________________ E-mail: _______________
Phone: (_____) _______-__________
| Kids | Adults | Call Sign | Name (please print) |
| _______ | ________ | __________ | __________________________________________________ |
| _______ | ________ | __________ | __________________________________________________ |
| _______ | ________ | __________ | __________________________________________________ |
Registration:
Convention Pins Included (Limited Supplies)
| Early Bird Dated before May 31, 2006 | $15.00 @ | _________ ea. | = $___________ | ||
| Pre-Registration 6-1-06 to 8-22-06 | $17.50 @ | _________ ea. | = $___________ | ||
| At Door Registration | $20.00 @ | _________ ea. | = $___________ | ||
| Accompanied kids under 16 year Free | |||||
| DX Breakfast Dinner | $20.00 @ | _________ ea. | = $___________ | ||
| Banquet Tickets ( ) Beef ( ) Chicken | $40.00 @ | _________ ea. | = $___________ | ||
| _____Banquet Speaker: Gordon West WB6NOA | |||||
| Convention Lunch | $23.00 @ | _________ ea. | = $___________ | ||
| _____Lunch Speaker: Bob Heil K9EID | |||||
| 2006 Convention Pins | $ 5.00 @ | _________ ea. | = $___________ | ||
| 2002 Convention Pins | $ 5.00 @ | _________ ea. | = $___________ | ||
| QSL Card Checking | |||||
|
Make Checks payable to:
Web Form ver 10.3 |
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Please note No Refunds
:-)