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Knights of Peter Claver 94th National Convention Special Events Order Form Personal Information Full Name: Unit/Position: Company: Address: Tel/Fax: Email: Do you have any handicap If yes, please give details: disabilities that require special transportation assistance? Do you have any special dietary If yes, please give details: requirements? Conference Event Ticket # Tickets Event # Event Location Total Price ordered Ladies Of Grace Gospel FR001 Hilton Riverside Hotel $10.00 Extravaganza SA001 KPC Hallowed Grounds Tour Mobile, AL $55.00 SA002 KPC Crescent City Tour New Orleans, LA $35.00 SA003 UNCF White Linen Night Dance Hilton Riverside Hotel $15.00 SU001 Centennial Gala Morial Convention Center $45.00 TU001 Masquerade Ball Hilton Riverside $20.00 Total Amount Due Payment Method (Select One) Check/Money Order Enclosed YES NO Credit Card: Card Number Expiration Date We can accept payment by Visa, MasterCard and Discover. There will be a small administration charge for this and the Card Holder’s Name Signature charge will be in $2.00. We cannot accept (Please Print) payment by American Express. If you wish to Your signature authorizes KPC to charge your pay by card please forward your card number credit card for the total amount due including and expiration date the administrative fee Please return your completed conference KPC National Convention registration form to Knights of Peter Claver, Inc 1825 Orleans Ave Please reply by June 30, 2009 New Orleans, LA 70116 United States of America Or fax your completed forms to (504) 821-4253 On-line Registration available at: www.kofpc.org Questions? Please call: (504)-821-4225 or email: firstname.lastname@example.org