Division 3 Convention Registration

  (Please Print All Information)

NAME: ______________________________GRADE:________CHAPTER:______

ADDRESS: _________________________________________________________

CITY: _______________________________STATE: ______ ZIP CODE: _______

EMAIL: ______________________________  PHONE: ______________________

STATUS (Circle One): AFSA -- AUX (Circle One): DIV OFFICER -- CH OFFICER -- OTHER

CHIEF DELEGATE FOR ACTIVE CHAPTER (Circle): YES -- NO

MEMBER AT LARGE (MAL) (Not assigned to active Chapter-Circle) YES

NAME OF GUEST: __________________________________________________

Is Guest a Delegate (AFSA OR AUX MEMBER- Circle) YES -- NO

REGISTRATION (Full Convention rate - Includes all 3 meals, refreshments  (coffee, tea, etc., during convention breaks).  Optional Events will be announced.

Pre-registration by 11 March is $75 ________   On Site Registration is  $85) _______  

SEPARATE FUNCTION RATES:  (Please Check Below and List Function(s) on Check)

Thursday Opening Dinner each person - Opening Night Theme is Hollywood  - "Lights! Camera! Action!"  so come dressed as your favorite film star  $30.00 each person:  Yourself  _______  Guest  _______

Friday Lunch - $15.00 each person: Yourself  _______  Guest  ________  

Saturday Installation/Honors Banquet each person -$40.00: Yourself  _______  Guest  ________  

TOTAL ENCLOSED _____________ Your Check # _____________

Note: Make all checks payable to "AFSA Chapter 358." Be sure to include name of Guest(s) on check unless name is pre- printed on check.  

MAIL REGISTRATION TO: Division 3 Convention Registration Chairman - Rob Casagrande, c/o AFSA Chapter 358, P.O. Box 65844. Langley AFB VA, 23665  757-851-1831 (home) 757-764-8321 (work)  mailto:robert.casagrande@langley.af.mil

Cancellation Policy:   Cancellation notification must be received by Registration Chairman 72 hours prior to start of convention for refund.