Registration Form Convention 2003 by zkd14107

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                                            In the Name of the Father, the Son, and the Holy Spiri t, One God, Amen
Virgin Mary & Archangel Michael                               Conventions Hotline: (877) 374-6812

     Coptic Orthodox Church                                87 Benham Street, Hamden, CT 06514
         Of Connecticut                      Phone: (877) 374-6812   Fa x: (877) 600-1006  www.coptnet.com


      Registration Form, East Coast Family Convention, Connecticut 2010
                    Saturday, Sunday, and Monday: July 3, 4, 5

 + Your Name:                               + Age:                 Please add you email for faster reservati on confirmation

 + Phone:                                                       Email: ………………………………………..…
                                                                Spouse Name:………………………………….
 + Address:                                                       Others/Children Name Date of Birth
                                                                1)…………………………………..        / /
                                                                2)…………………………………..        / /
 +Your Church Name, City and State                              3)…………………………………..        / /
                                                                4)…………………………………..        / /

                Room                          Number of Rooms              Number of Nights                    Total
 2 Beds = $139.00 Per night
 (2 nights = $278.00)
 One bed = $119.00 Per night
 (2 nights = $238.00)
Meals & Drinks (Saturday Dinner, Sunday Breakfast, Lunch & Dinner, Monday Brunch)
(Adult and above 12 years old = $59.00) (Children 3 – 12 years old = $39.00) (Unde r 3 years old = Free)
   All Meals per Adult = $59.00         All Meals per Child = $39.00        Unde r 3 years old     Total
 Number of Adults                    Number of Children                    All Meals = Free
         X $59.00 =                             X $39.00 =                     X $0.00 = $0.00


(Sorry, we cannot reserve any rooms without meals)                                    All Totals =

 Credit Card: Visa( ) Master Card( ) Ame rican Exp( ) Discover( )
 CC Number:                                 Name:
                                            Phone:
 Expiration Date:                           CVC: (3 or 4 digit numbers, which are listed on the back of the card)

 Signature:                         Date:                Billing Address if Different:

OR, Make your check payable to:                           Virgin Mary Convention 2010
                                                          87 Benham Street, Hamden, CT 06514

        Hotline: (877) 374-6812       Fax: (877) 600-1006          Email:ECFC10@CoptNet.com

   As per hotel request, reservation after June 25th, will add $25.00 extra per
                                 room per night

								
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