New Year’s Day Parade London  2011
Convention Registration Form




There are no multiple registrations available. Please complete this form in its entirety for each individual being registered.

Fields marked by an asterisk (*) are required.

Please enter your chapter information
Roommate:
Your passport number:
Your passport expiration date:
*Emergency contact name:
*Emergency contact phone number:
Personal Information
Supporting Membership ID:  - 
*First Name:
*Last Name:
*Street Address:
Unit Number (if applicable):
*City:
*State/Province:
*ZIP or Postal Code:
*Country:
Please enter your Email Address
for speedier confirmation and event updates.
*Phone:
Convention Options
*Program Package
Choose a Departure Gateway City or Land package only. You may pay in full, or pay a deposit. The remaining balance will be due by September 30, 2010 
1. Depart from New York, NY (JFK)    $3,023.00
1a. Deposit for departure from New York, NY (JFK)    $300.00
2. Depart from Washington, DC (IAD)    $3,048.00
2a. Deposit for departure from Washington, DC (IAD)    $300.00
3. Depart from Chicago, IL (ORD)    $3,064.00
3a. Deposit for departure from Chicago, IL (ORD)    $300.00
4. Depart from Los Angeles, CA (LAX)    $3,126.00
4a. Deposit for departure from Los Angeles, CA (LAX)    $300.00
5. Depart from San Francisco, CA (SFO)    $3,126.00
5a. Deposit for departure from San Francisco, CA (SFO)    $300.00
6. Land Only    $2,086.00
6a. Deposit for Land Only    $300.00
7. Depart from Atlanta, GA (ATL)    $3,025.00
7a. Deposit for departure from Atlanta, GA    $300.00
Are you a Red Hatter or a Pink Hatter?
We want to know who you are! Please tell us if you are a pink hatter or a red hatter. 
I am a Pink Hatter.
I am a Red Hatter.
Not applicable
*Single Occupancy Supplement
I prefer to have a room by myself for an additional $480 
1. Yes    $480.00
2. No, thanks
*ADA Accomodations
Do you have special ADA accommodations for the convention (i.e. wheelchair access, listening devices, etc.)? We will contact you for more details. 
1. No, I do not have special ADA needs.
2. Yes, please contact me for more information.
Hotel Accommodations
Please indicate your hotel preference: 
1. Single Room (I am not sharing)
2. Double Room (seperate beds)
3. Couple Room (single bed)
Tour Choice for Sunday
Please select the tour that you'd like to participate in 
Bath & Stonehenge
Windsor & Oxford
*Travel Insurance
If you have enjoyed your 71st birthday, the cost of insurance is $40. 
I am 71 or wiser    $40.00
I am under the age of 71