CENTRAL 2008
RECEPTION TABLE FORM
APRIL 16
– 19, 2008, THE PALMER HOUSE HILTON,
Fax this form with
your credit card payment to Linda Smallbrook (302-831-3372). No cover sheet is needed. Or, if you prefer, mail this form with your
payment to Linda Smallbrook, APA,
Payment must accompany your registration form.
IMPORTANT NOTE: ALL TABLE RESERVATIONS MUST
BE PAID FOR AT THE TIME OF PLACING THE RESERVATION. WE WILL BE UNABLE TO PROCESS YOUR FORM WITHOUT
THE ACCOMPANYING PAYMENT. THANK YOU FOR
YOUR UNDERSTANDING.
Receptions are scheduled to be held in the Red Lacquer Room on April 17th (8:30 p.m. to
midnight) and in the Red Lacquer Room
on April 18th (9:00 p.m. to
midnight). The first night reception
provides beer and soft drinks at no charge.
Admittance is by registration
name badge or ticket only. The
second night reception is a cash bar.
The charge for a table at both receptions is $25.00 total. The deadline
for receipt of reservations is April 1st . After that time we will still take
reservations but your school’s name will not appear in the handout.
To reserve a table, please complete the following
and return to Linda Smallbrook, APA,
Name:_________________________________________________________________
School/Organization:_____________________________________________________
E-mail
address:
________________________________________________________
Please
select an option for payment and fill out the form completely if paying by
credit card.
___ 1) Check*
(Payable to APA)
*The APA can only accept checks drawn on a
U.S. bank, in U.S. Dollars.
___ 2) Visa MasterCard Exp.
Date
Last 3 digits on back of
card
Name as
it appears on Card:___________________________________________________
Signature
of Authorization:_____________________________________________________
Email:____________________________________ Phone
#:_________________________