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 AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* PhoneHIDDEN-Please provide the number of children attending with you so we have an accurate headcount:Please enter a number greater than or equal to 0.Registration FeesRegistration Type: IF YOUR SPOUSE (OR A GUEST) IS ATTENDING - CHOOSE COUPLE REGISTRATION$379 Couple -CECA Member (After May 20th $399)$329 Individual CECA Member (After May 20th $349)$400 Individual Non-Member$500 Couple Non-MemberGolfGolf is $150 per player.Number of Participants for Golf Event - Pine Lakes Course0121st Golfer's Name First Last 1st Golfer's Handicap2nd Golfer's Name First Last 2nd Golfer's HandicapTotal Price for Golfer(s) Price: $63.00 Brunch and Painting ClassSpouse Tour – Painting in Paradise - Brunch and Painting Class Adult to attend Brunch and Painting Class Price: $140.00 Quantity: ages 19 and up will be considered an AdultNumber of kids to attend Brunch and Painting Class Price: $65.00 Quantity: ages 8 to 18Number of kids to go to Childcare Price: $40.00 Quantity: Name(s) and Age(s) of children going to Childcare during Painting ClassAdult Name to attend Brunch and Painting Class First Last CornholeCorn Hole Tournament Registration:NoneOne PlayerOne Team$10 a player or $20 a team.Name of First Corn Hole player First Last Name of Second Corn Hole player First Last I would like to have my logo on the CECA Convention T-shirts for $144:No, do not include my logo on the T-ShirtYes, please include my logo on the T-ShirtEach Registrant, Spouse/Guest and Children will receive a Convention T-Shirt. Those who would like to be a sponsor the shirts will have their company logo on the back of the shirt. Only one person from a company should sign up for this. To have your company logo included on the t-shirts, you must sign up by May 20th. This sponsorship opportunity is for CECA Members Only. Logo I have sponsored the shirt in the past and you have my logo I will send my logo to firstname.lastname@example.org SponsorshipI would like to be a Sponsor of the CECA Convention:No SponsorshipPlatinum Level - $5000Gold Level - $1000Silver Level - $500Bronze Level - $250Other AmountOther Amount T-Shirt Sizes - Each Registrant, Spouse/Guest and Children receive a Convention T-ShirtYour T-shirt Size:SmallMediumLargeExtra LargeXXL3XL4XLSpouse/Guest Shirt SizeNoneSmallMediumLargeExtra LargeXXL3XL4XLPlease provide the number of children attending with you so they will receive a CECA Convention T-Shirt (there is no charge).012345Would you like for your children to have a name tag?YesNo1st Child's Name1st Child's T-shirt Size:NoneToddler 2TToddler 3TToddler 4TToddler 5/6Youth YSYouth YMYouth YLAdult SAdult MAdult LAdult XLAdult 2XLAdult 3XLAdult 4XL2nd Child's Name2nd Child's T-shirt Size:NoneToddler 2TToddler 3TToddler 4TToddler 5/6Youth YSYouth YMYouth YLAdult SAdult MAdult LAdult XLAdult 2XLAdult 3XLAdult 4XL3rd Child's Name3rd Child's T-shirt Size:NoneToddler 2TToddler 3TToddler 4TToddler 5/6Youth YSYouth YMYouth YLAdult SAdult MAdult LAdult XLAdult 2XLAdult 3XLAdult 4XL4th Child's Name4th Child's T-shirt Size:NoneToddler 2TToddler 3TToddler 4TToddler 5/6Youth YSYouth YMYouth YLAdult SAdult MAdult LAdult XLAdult 2XLAdult 3XLAdult 4XL5th Child's Name5th Child's T-shirt Size:NoneToddler 2TToddler 3TToddler 4TToddler 5/6Youth YSYouth YMYouth YLAdult SAdult MAdult LAdult XLAdult 2XLAdult 3XLAdult 4XLDo you have any children that will be attending the kid's party?*NoYesCECA Kids PartyThe CECA Kids Party will be held nightly from 6:45-11:00 pm at the Marriott Grande Dunes Resort. We will provide the children with dinner each evening along with an exciting Beach Kids Party with carnival games, crafts, and prizes. Dinner will be a kid’s meal of a choice of either: a hamburger or chicken fingers, fries, a cookie, lemonade, and water. The Kids Party is $67 per child per night. Sitting Service for special needs children is available at no extra charge. Contact Kendall at the CECA Office for information. * As always, the children are welcome to attend all CECA Events. The Kids Party is an alternative for the children.Number of kids attending the Kid's Party12345Total nights your children will attend the Kid's Party*123Nights you children will attend the Kid's Party Thursday Friday Saturday Name, Age, & Dinner Choice of children going to the Kids PartyDinner Choice is Hamburger or Chicken Fingers. This is required for your sitting service.Kid's Party Total Price: $67.00 Please indicate any food allergies for your children:Billing 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 ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 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. Section BreakNameThis field is for validation purposes and should be left unchanged.