Convention Registration (Step 1 of 3)

Venues
Conference and accomodations will be at the The Ritz Carlton, Buckhead.
Golf outing at The Frog.
Sporting clays at Cherokee Rose Sporting Resort.

Registration Deadlines
Convention Registration: October 9, 2012
Hotel Reservation: September 14, 2012

Register by Fax
If you prefer to register by fax, please print the registration form (PDF format) and fax it to (847) 674-7366

Need help?
Email info@mflassociates.com or call (847) 673-2013.

* Indicates required field

About Me

First Name*:
Middle Initial:
Last Name*:
Name for Badge:	If different than name entered above
Firm Name:

Please use the billing address on file with your credit card company

Phone*:	(XXX) XXX-XXXX
Fax:	(XXX) XXX-XXXX
Email*:	A confirmation email will be sent to this address

Registration*:
With Guest/Spouse?:	Guest/spouse: $100
Guest/Spouse Name:
Golf - The Frog:	Golf: $200/person - for me (Buy Side Complimentary) Golf: $200/person - for my guest
Sporting Clays - Cherokee Rose Sporting Resort:	Sporting Clays: $175/person - for me (Buy Side Complimentary) Sporting Clays: $175/person - for my guest

I will attend the:

Thursday Business Meeting
Thursday Gala Reception

Credit Card:	Visa, MasterCard or American Express
Card Number*:
Name on Card*:
Expiration Date*:	/

To hotel reservations (optional)