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2013 Oregon BeaveRG XV
May 10, 11, 12 - 2013
Red Lion Hotel - Convention Center
Print /// Fill-Out For Each Attendee /// Mail.
|Name for Badge: || |
|Name of Member / Attendee: || |
|Address: || |
|City State Zip: || |
|Phone: || |
|E-mail: || |
|Is This attendee under age 21? (Y/N)|| |
|Registration fee: |
Before 2013-Feb-28 $60
Before 2013-Apr-15 $70
under 18 if accompanied by paying adult $40
|Sat. Banquet @ $30||$|
|Sun. Brunch @ $20||$|
|RG T-Shirt @ $15 |
Please Circle: S M L XL
Make Checks Payable to:|
Oregon Mensa RG
Mail Rgistration Form To:
3011 NW 23rd Ave.,
Camas, WA 98607-8094.
|If paying by credit card, circle: ||
VISA MasterCard American Express |
|Name as printed on card: || |
|Credit card number || |
|Expiration month / year: || |
For Red Lion Hotel reservations, please call 503-235-2100 or toll-free 800-343-1822.
Ask for special Oregon Mensa hotel rate: $72.00 plus tax (single, double, triple, quad) available until April 10, 2013. Cancellation deadline for no-charge is "April 15, 2013."|
For more RG info, email email@example.com , or call 360-834-6020.
Refund policy: full refund for cancellation notice received by Registrar by April 16.
You can find this registration form on-line, and more information, at the Oregon Mensa website: http://www.oregon.us.mensa.org