Counselor Magazine July 2012 : Page 11
2012 ASI Power Summit November 11-13, 2012 Registration Form The Ritz-Carlton Golf Resort, Naples Please complete and fax to (800) 546-1215 HURRY! Hotel rooms are going fast ! Save $200! The registration fee for the ASI Power Summit is $1,995* for the ﬁ rst individual from each company, and $1,595* for each additional person. Hurry! Offer ends August 31, 2012! Reserve your room at the luxurious Ritz-Carlton Golf Resort of Naples and receive the discounted rate of $235/night.* Attendees First Power Summit Attendee: Name __________________________________________________ Title ___________________________________________________ Company _______________________________________________ asi/ ___________________________________________________ Email __________________________________________________ Please tell us your shirt size: __________ shoe size: __________ Second Power Summit Attendee: Name __________________________________________________ Title ___________________________________________________ Email __________________________________________________ Please tell us your shirt size: __________ shoe size: __________ ❑ Signiﬁ cant other will attend both dinners. Total $795* ❑ Signiﬁ cant other will attend both dinners. Total $795* Billing Information Mailing Address Street__________________________________________ City_________________________________ State______ Zip______________ Billing Address ❑ Same as mailing address Street__________________________________________ City_________________________________ State______ Zip______________ Payment Information ❑ American Express ❑ Discover ❑ MasterCard ❑ VISA Cardholder’s Name ____________________________________________ Signature ___________________________________________ Card Number _____________________________________ Exp. Date _______________ Four-or Three-digit Security Code _________ Please select ONE of the following recreational activities scheduled for the afternoon of November 12. ❑ Golf – If you select golf, please complete the information below. What is your handicap? ___________ For clubs, please select one of the following: ❑ I need to rent right-handed clubs ❑ Tennis ❑ Spa (Fees may apply) Please let us know of any special needs (examples may be dietary restrictions, disabilities, etc.): ________________________________________________________________________________________________________________ Please indicate the topics you would like to discuss at the Power Summit: ________________________________________________________________________________________________________________ ❑ I need to rent left-handed clubs ❑ I will bring my own clubs *Fees reﬂ ect pricing for ASI members only. Pricing does not include tax or hotel fees. No refunds or cancellations. 4800 Street Road, Trevose, PA 19053-6698 (800) 546-1350, option #1 PH (800) 546-1215 FX email@example.com www.asicentral.com © 2012, Advertising Specialty Institute ® . All Rights Reserved. 580-825970 0612 For more information, contact ASI’s customer service team at (800) 546-1350, option #1.