2023 CECA Convention Registration Form Name* First Last Spouse/Guest Name First Last Company Name* Lifetime Members, please put Lifetime Member or the company from which you retired.Mailing Address* Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* PhonePlease provide the number of children attending with you so we have an accurate headcount for kid friendly food and drink amounts:Please enter a number greater than or equal to 0.Child 1 Name First Last Child 2 Name First Last Child 3 Name First Last Child 4 Name First Last Child 5 Name First Last Registration FeesRegistration Type:$449 Couple Member$399 Individual Member$479 Single Non-Member$529 Couple Non-MemberNumber of Participants for Golf Event - Pine Lakes Golf Club Quantity Price: $165.00 Quantity Golf will be straight Captain's Choice, so you may send us your team names or we will be glad to assign you to a team. Golfer 1 Name First Last Golfer 1 HandicapGolfer 2 Name First Last Golfer 2 HandicapSpouse Event – Painting in Paradise - Brunch and Painting Class ClassAdult to attend Painting in Paradise Class - Includes Brunch & Drinks Quantity Price: $140.00 Quantity Ages 21 and up will be considered an AdultNumber of kids to attend Brunch and Painting in Paradise Class Quantity Price: $65.00 Quantity Ages 8 to 20Adult Name 1 to attend Brunch and Painting Class First Last Adult Name 2 to attend Brunch and Painting Class First Last Corn Hole Tournament Registration:No Corn HoleOne Corn Hole PlayerOne Corn HoleTeam$20 a player or $40 a team.Name of Corn Hole player 1 First Last Name of Corn Hole player 2 (if team) First Last I would like to sponsor the CECA Convention T-shirts for $152:No, I would not like to sponsor the Convention T-ShirtYes, I would like to sponsor the Convention T-ShirtsEach Registrant, Spouse/Guest and Children will receive a Convention T-Shirt with the logos of the shirt sponsors on the back of the shirt. Only one person from a company should sign up for this. This sponsorship opportunity is for CECA Members Only. SponsorshipI would like to be a Sponsor of the CECA Convention: We have new Sponsor Levels AvailableNo SponsorshipTitle Level - $5000Platinum Level $2500Diamond Level $1500Gold Level - $1000Silver Level - $500Bronze Level - $250Other AmountPlease consider giving a sponsorship to help us offset the hotel's food and beverage price increases. Sponsors will be recognized with signage at the Convention, recognition on their name tags and recognition in the Carolina Current Magazine. Other Amount T-Shirt Sizes - Each Registrant, Spouse/Guest and Children receive a Convention T-ShirtYour T-shirt Size:SmallMediumLargeExtra LargeXXL3XL4XLSpouse/Guest Shirt SizeNoneSmallMediumLargeExtra LargeXXL3XL4XLChild 1 T-shirt Size:NoneToddler 2TToddler 3TToddler 4TToddler 5/6Youth YSYouth YMYouth YLAdult SAdult MAdult LAdult XLAdult 2XLAdult 3XLAdult 4XLChild 2 T-shirt Size:NoneToddler 2TToddler 3TToddler 4TToddler 5/6Youth YSYouth YMYouth YLAdult SAdult MAdult LAdult XLAdult 2XLAdult 3XLAdult 4XLChild 3 T-shirt Size:NoneToddler 2TToddler 3TToddler 4TToddler 5/6Youth YSYouth YMYouth YLAdult SAdult MAdult LAdult XLAdult 2XLAdult 3XLAdult 4XLChild 4 T-shirt Size:NoneToddler 2TToddler 3TToddler 4TToddler 5/6Youth YSYouth YMYouth YLAdult SAdult MAdult LAdult XLAdult 2XLAdult 3XLAdult 4XLChild 5 T-shirt Size:NoneToddler 2TToddler 3TToddler 4TToddler 5/6Youth YSYouth YMYouth YLAdult SAdult MAdult LAdult XLAdult 2XLAdult 3XLAdult 4XLBilling InformationPlease make sure the following information is as it appears on the credit card statement to ensure proper billing.Billing Amount: $0.00 Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name CANCELLATION POLICY: Full Refund prior to May 24th; $100 Service Charge, May 25th - June 1st; No Refunds after June 1. NameThis field is for validation purposes and should be left unchanged.