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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: info@kofpc.org