Great company, good cheer and beautiful Belleek!  Join us!      
      Please return both pages with all information completed and all fees.

Register by Nov. 1, 2008 to be eligible for a special Belleek drawing!  Deadline is Feb. 1, 2009.  No refunds of
the convention fee of $425US will be made after March 1^st unless there is a replacement registration.
Room price of $139 is for one or two people and includes breakfast for two.  If you are interested in sharing a
room, please check here and you will be put in touch with others interested in sharing a room. 
 _____Yes, I am interested in information on a room share. 

 Please Print
                     First Name                                          Last Name                           Email address

 1.

 2.

 3.

 4.

 Mailing address

 City                                                        State                               Zip code/country code

 Telephone number

 Chapter name:
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Convention fee $425US per person.   Make check or money order payable to North Jersey Chapter BCIS

Total enclosed $_____________________US.
If paying by credit card, registration is $438US per person to cover the credit card charge.
 (circle one)   registration fee of $438US           VISA   or  Master Card.
Credit card charges will appear as C2W-Creations, LLC.

Account Number                                                                                         Expiration Date

Security code on card

Name on card

I authorize the total of $ ____________US to be charged for registration fee/s and the total of $__________US
for tour fee/s.

Signature
 
Mail to:  Patricia Hennessey    38 Woodland Drive    Brightwaters, NY 11718    USA
Questions:  email hennesseypatricia@hotmail.com or call 631-665-4680