Arkansas PTA Convention Registration

Arkansas PTA 77^th Annual Convention
Advance Registration Form
April 26 & 27, 2002, Radisson Hotel, Fayetteville

Please print this Web page to your printer. Legibly print or type. Register only ONE person per form. Make copies as needed. Mail the completed form(s) to Arkansas PTA, P.O. Box 1015, North Little Rock, AR 72115. Advance Registration due by April 15, 2002.

ALL Registrants must present their 2001-2002 PTA membership card in order to receive convention materials. VOTING DELEGATES must present a valid credential card (sent to unit in mid-April) and their current PTA membership card to receive a voting card.

Registrant Name __________________________

Address __________________________________

City ________________________ ZIP ________

Daytime Phone (___)_______________________

Evening Phone (___)_______________________

  PTA Region _______________________

  Unit Name ________________________

  __________________________________

  Council (if applicable) __________

  __________________________________

Check appropriate box(es): Ť Voting delegate Ť Non-voting delegate Ť Honorary ARPTA Life Member

REGISTRATION (circle appropriate fees)

	Advance Registration by April 15	On Site Registration
*Registration Fee	$25.00	$30.00
*Student Registration (student delegate)	$15.00	$20.00
**Registration & All Meals Package*	$70.00

*Registration fee is required for attendance at general sessions, workshops sessions, or special occasions.

Individual Meals
(Indicate all meals desired. Guests may attend meal functions with the purchase of a ticket.)

	Price	# of tickets		Total Amount
April 26 Reflections Luncheon, 12:00	$15.00	X _____	=	$______
April 26 Awards Banquet, 6:45 p.m.	$20.00	X _____	=	$______
April 27 Membership Luncheon, 12:00	$12.00	X _____	=	$______

FOR OFFICE USE ONLY Payee ___________________________________ Date Received ___________________________ Check# __________________________________

TOTAL REMITTED $________

ROOM RESERVATION REQUEST FORM

ARKANSAS PTA
April 26 & 27, 2002
Radisson Hotel Fayetteville

Check-in date  _____/_____/_____ (Month/Day/Year)
Check-out date _____/_____/_____ (Month/Day/Year)

Number of Rooms ________   Type Requested ________________
Room Rate: $69

NAME (please print) ________________________________________________________

Address ____________________________________________________________________

City/State/Zip _____________________________________________________________

Daytime Phone (Home) ________________________ (Work) _______________________

Fax number ________________________ E-mail _________________________________

Credit Card # ____________________________________ Expiration Date ____/____

Signature ___________________________________________ Date _____/_____/_____
(RESERVATION IS INVALID WITHOUT SIGNATURE)

Names of Additional Persons sharing a room:

_____________________________________________

_____________________________________________

_____________________________________________

Please fill out this form completely and fax or mail it to Tamara Lunsford
Front Office Manager
Radisson Hotel Fayetteville
70 N. East Avenue
Fayetteville, AR 72701
(479) 442-5555 Fax (479) 442-2105
Upon confirmation of your reservation any cancellations that you may need to make must be made and received by March 25, 2001. This must be made to avoid any cancellation charges to your credit card, and remember to ask for cancellation number.

Click on the map to link to MapBlast! where you can then zoom in or out.

Email Jeannie Cole, state president

Link to Arkansas PTA Home Page

Link to National PTA Home Page

This Web page was last updated on 2 February 2002