Registration Form
 

Last Name:    First Name:  
                      (As on Government issued picture ID)

Phone - Work:   Cell:     Email:    
  (must include dash in phone fields)

Company Name:

Address:  

City:   State:   Zip:   Country:  

Air Travel

Need Air Reservations:   YES No

Departure Airport:    

Departure Date: June  Date 20 21 22 23 24 25 26 27 2008;     Departure Time: Select 1 2 3 4 5 6 7 8 9 10 11 12 AM PM

Return Date: June  Date 23 24 25 26 27 28 29 30 2008;     Return Time: Select 1 2 3 4 5 6 7 8 9 10 11 12 AM PM

Seat Preference: Aisle Seat Middle Seat Window Seat      Air Line Preference:  

Special Air Request: 
                                 (Ex. Frequent Flyer Number, traveling with other)

Hotel

The Westin Casuarina Hotel
160 E. Flamingo Rd., Las Vegas, NV 89109
Rates: $155/nt plus tax
 

Need Hotel:  Yes No

Room type: King Two Double Beds    Total # of Occupants: 1 2 3 4    Preference: Smoking Non-smoking (Subject to availability)

Special Hotel Request:

Car Rental
Avis Car Rental has been contracted with special rates.

Need Car Reservation:  Yes No

Car Size: Select One Economy Compact Intermediate Full Minivan SUV Convertable   Rental Car Company Preference:

Car Rental Priority Number:    Special Car Request: