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* PhonePlease provide the number of children attending with you so we have an accurate headcount:Please enter a value greater than or equal to 0.Press + after last child to add additional childrenIf you want your child(ren) to have a name tag, please list their name(s) here.Child's Name First Last Registration FeesRegistration Type:$379 Couple Member - Early Bird Rate$329 Single Member - Early Bird Rate$399 Couple Member (After May 11th $399)$349 Single Member (After May 11th $349)$400 Single Non-Member$500 Couple Non-MemberNumber of Participants for Golf Event - Pine Lakes Course Price: $150.00 Quantity: Press + to add golfersGolfer's Name First Last Golfer's Handicap Corn Hole Tournament Registration:NoneOne PlayerOne Team$10 a player or $20 a team.Press + to add another playerName of Corn Hole player First Last I would like to have my logo on the CECA Convention T-shirts for $140: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 10th. Logo I have sponsored the shirt in the past and you have my logo I will send my logo to email@example.com 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 LargeXXL3XL4XLPress + to add another child shirtChild T-shirt Size:NoneToddler 2TToddler 3TToddler 4TToddler 5/6Youth YSYouth YMYouth YLYouth YXLAdult SAdult MAdult LAdult XLAdult 2XLAdult 3XLAdult 4XL CECA 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 PartyNumber of nights attending the Kid's PartyPlease enter a value less than or equal to 3.Price of Kid's Party Price: $63.00 Press + after Allergies to add another childChild's Name First Last Child's AgeNights attending Children's Party Thursday Friday Saturday Meal Choice (Thursday)HamburgerChicken FingersMeal Choice (Friday)HamburgerChicken FingersMeal Choice (Saturday)HamburgerChicken FingersPlease indicate any food allergies your child has: 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 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 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.