Name:                     

Street Address:     

City:                             State:      ZipCode:  

Email Address:     

Phone:                    

Staying at the Convention Hotel:    YES    NO

Events you are planning to attend (fill in the number of persons attending each event):

    Thursday:           NEHG      Casual Dinner  

    Friday:                 NEHG      Casual Dinner  

    Saturday:           Morning AS meeting     

                                   Ames Society Dinner     

Total number of persons attending on this form   @ $20 each = $ 
          Please make checks payable to:  The Ames Society

If you are seeking a roommate to share the cost, please contact our President.

Cancellation Policy:  All cancellations must be received in writing or email
          prior to September 1, 2012. No refunds after that date.

Reminder:  Information can be found on the Convention webpage.  Call the hotel directly
          to get the Ames Society group rate on your hotel reservation.

Please print and mail this form and payment to:
          The Ames Society, 1660 Jennings Mill Rd, #304, Bogart, GA  30622

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