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FLORIDA SHORE & BEACH P.O.Box 13146 <br /> Tallahassee,Florida 32317-3146 <br /> PRESERVATION ASSOCIATION (850)906-9227 <br /> mall@fsbpa.com <br /> A League of Cities and Counties on Beach and Coastal Issues www.fsbpa.com <br /> IL <br /> 57th FSBPA Annual Conference Registration Form <br /> September 25-27, 2013 1 Delray Beach Marriott I Delray Beach, Florida <br /> REGISTRATION FEES <br /> Early Registration Regular Registration <br /> through August 28,2013 after August 28, 2013 <br /> ❑ Member Registration $325 O Member Registration $375 <br /> ❑ Non-Member Registration $375 LJ Non-Member Registration $425 <br /> ❑ Spouse/Non-Business Guest$125 * ❑ Spouse/Non-Business Guest $125 <br /> ❑ Full Time Students$125 ** LJ Full Time Students$125 ** <br /> * Spouse/Non-Business Guest registration fee includes Welcome Reception and Awards Banquet CAIw6ELtTION POLICY: <br /> ** Students must provide current student ID Carlla4vortEee ;SQ <br /> F�BPAnaustrece Epncellatton <br /> SELECT YOUR ENTREE selection for the Awards Banquet uesovrfi,6rema�yr - <br /> Thursday.September 26,2013 than <br /> ❑ Grilled Grouper SepTipp- l8tZQ23 Send <br /> ❑ Filet Mignon"Au Poivre" niqueest to SSRA aa ions, <br /> ❑ Vegetarian Meal POBox-4346, a1TQfiasse`e,FL <br /> 323fyot mar7ma'ilfcsfs6axom <br /> ❑ Not Attending Banquet <br /> Name <br /> Title <br /> Organization <br /> Address <br /> City State Zip <br /> Telephone Fax E-mail <br /> Spouse's Name, if registering and attending: <br /> Spouse's Entree Selection for Awards Banquet <br /> We also accept these credit cards: Please make checks pa <br /> American Express • MasterCard • VISA• Discover <br /> FSBPA <br /> 13146 <br /> e X132317 <br /> �w <br /> Credit Card Number: Expiration Date Security Code <br /> 3 or 4 digit code on back of card <br /> Cardholder Name <br /> Cardholder Signature <br /> If you our paying by credit card,you can FAX the form to 850-201-6782 or email to mail(icfsbna.com <br /> 12 <br />