2008 USPTA World Conference registration form
2008 USPTA World Conference registration form

Save up to $100 by registering by Aug. 15!

Main registrant
First name:
Last name:
Address:
Address 2:
City:
State:
ZIP:
Country:
USPTA member No.: 
Division:
Nonmember:
e-mail:
Home phone:
Work phone:
If you are interested in testing or upgrading, please check here.

Please indicate parties you plan to attend:

Wednesday night  Thursday night
Thursday awards breakfast    
If you wish to receive the vegetarian meal option, please check here.

Arrival date: Departure date:
Are you staying at La Quinta Resort & Spa? Yes No  
If not, why?  

I have already registered for the USPTA World Conference.

Fees
By Aug. 15
Aug. 16 or later
Member
$295
$345
Nonmember
$340
$390
Subtotal 1    

Specialty course (Click here for the list of specialty courses)
No. 1 No. 2 No. 3 No. 4 No. 5
No. 6 No. 7 No. 8 No. 9 No. 10

   Specialty course fees

First course
Second course
Additional courses $30 each

$40
$35
x =

Subtotal 2    

Guest registration
(Guests must be registered to attend parties.)

First name:
Last name:
Division:
USPTA member No.: 
Nonmember:
   

Please indicate parties you plan to attend:

Wednesday spouse/guest luncheon Thursday awards breakfast
Wednesday night   Thursday night
If you wish to receive the vegetarian meal option, please check here.

Fees
 
By Aug. 15
Aug. 16 or later
Guest
none
$135
$185
   Subtotal 3    

Child registration
(Registration fee includes special menu at nightly parties and promotional giveaways for children ages 5-12. Children ages 13-18 receive adult package.)

Child 1 Age
Child 2 Age
Child 3 Age
Child 4 Age

Fees per child
Quantity
  
Child (5-12) registration
x $60=
    
Child (13-18) registration
x $110=
    
Subtotal 4    

Total fees

Subtotal 1
Subtotal 2
Subtotal 3
Subtotal 4
Grand total

Payment options

Check here if credit card billing address is the same as the address above. If different, fill in the address information below.

First name:
Last name:
Cardholder address:
City:
State:
ZIP:
Country:
Credit card:
Card No. :
Expiration date :
Security code*:
Signature:  
*How to find your security code:
Visa and MasterCard – On the back of your card, locate the final 3-digit number.
American Express – On the front of your card, locate the 4-digit number on the top right corner.

This is a secure form. However, if you would prefer to mail in your form, send it to
USPTA, 3535 Briarpark Drive, Suite One, Houston, TX  77042, or fax to 713-358-7785.