NOTE: YOU MUST TAB THROUGH THE FORM TO MOVE FROM FIELD TO FIELD
AND FOR THE FORM TO ADD AMOUNTS AUTOMATICALLY.

 
Date:


Company Name:
Name (Principal):
Guest Name:
Guest Name:
Guest Name:

2009 Special Functions
# Attending
# Attending

Thursday Hospitality Reception
8:00 pm -10:00 pm December 3

Friday Member/Vendor Dinner
7:00 pm - til December 4

Friday Night Cocktail Reception
6:00 pm - 7:00 pm December 4
 

Yes, have someone contact me about how I can benefit by presenting My Product Education during the next conference.

Registration Fee
By October 30
(Early Discount)
After October 30
#Attending
Booth Rental Fee $300.00
$300.00
x
1
= $ 300.00
1st PremierDPH Vendor $650.00
$700.00
x
1
= $ 700.00
Additional Vendor (2nd or more) $600.00 each
$650.00 each
x
= $
Guest/Spouse (Not in DPH Industry) $400.00 each
$400.00 each
x
= $

Registration Payment

Sent check - Payable to: Buying Group Services
Total Amount Due $
Charge My Credit Card VISA
Account Number: Expiration Date:
Name on Card:    
Billing Address:
City: State:
Zip:
Send registrations with payment to: BGS Accounting, Post Office Box 4100, New Orleans, LA 70178
or FAX TO: Lesley Hardin @ 504-486-5273.

Cancellation Policy
Cancellations must be made in writing (fax to 504-486-5273) and received by November 23, 2009. No refunds after November 23, 2009. Hotel reservations must be cancelled in accordance with the Hilton Anatole policy.

Hotel Reservations

Make your reservations with Hilton Anatole
(use group designation PLL) 		Call direct: 800-HILTON

or go Online: www.PremierDPH.com
Hotel Cut off Date: November 23, 2009 5:00 pm

PremierDPH Discount Rate: $149.00 single or double


Special Needs and/or Dietary Restrictions Name:
ADA Requirements: Name:

Note: Registration fees include all conference sessions, materials, and scheduled meal functions.

BEFORE YOU CLICK SUBMIT, PLEASE PRINT A COPY FOR YOUR RECORDS. IF YOU DO NOT RECEIVE CONFIRMATION WITHIN 5 DAYS, PLEASE CALL ANNIE AT 504-486-5173.