Credit Union: Select Bennington E/E Federal Border Lodge Bryant Federal Caswell Central VT Med Center, Inc. Champlain Valley Covered Bridge Credit Union of Vermont CVPS Employees' Granite Hills Green Mountain Heritage Family Federal Members 1st Members Advantage Community New England Federal NorthCountry Federal Northeast Schools and Hospital Opportunities Orlex US Government ECU P.M.H. River Valley Rutland Cty Teachers/Mun. ECU St. Patricks Parish United Community VT Federal VT State Employees VT VAF Employees Federal White River Windham County VEA Windsor County South or Company:

Contact Person: Contact Email:

Contact Phone:

Registrant & Guest (if applicable)

First Name: Last Name:

Position / Title (for badge):

Registrant Email:  Guest's full name:

1. Discount Package(s)

Couple's 3 Night Weekend* ($1,435)......................................No Yes

Couple's 2 Night Weekend ($1,025)......................................No Yes 

Individual's 3 Night Weekend* ($1,050)..................................NoYes 

Individual's 2 Night Weekend ($735).....................................NoYes

Executive's 2 Night Package ($635)......................................NoYes

Education & Entertainment ($450)........................................NoYes 

Commuter's 2 Day Weekend ($350)......................................NoYes 

Guest's 3 Night Hospitality ($380)........................................NoYes 

Guest's 2 Night Hospitality ($250)........................................NoYes

Check this box ONLY IF this registrant's room should contain two double beds instead of a single king/queen bed.  Additional notes:

*These packages include the Executive Summit Dinner for one or two persons.  Please select your entree(s) in the a la carte section below but leave the # of meals at 0.

2. A la Carte selections 

   Accommodations ($219 per room, per night) Thursday   Friday   Saturday

  (Use the box in # 1 above to request two double beds instead of a single king/queen room)

  Meals & Training

0 1 2 Executive Summit Dinners @ $135 each Please select entree(s) One Tournedos of Beef Two Tournedos of Beef One Salmon Two Salmon One of each entree

0 1 2 3 4 Friday Continental breakfasts @ $18 each

0 1 2 3 4 Friday dinners & speakers @ $65 each

0 1 2 3 4 Saturday breakfasts @ $35 each

0 1 2 3 4 Saturday lunches @ $40 each

0 1 2 3 4 Saturday Anniversary Dinners & Entertainment @ $90 each

0 1 2 3 4 Sunday breakfasts @ $35 each

0 1 2 Training Pass to all weekend presentations @ $100 each

3. Optional Annual Yearbook & Directory Ad: Select: Full page ($225) Half page ($175) Quarter page ($125) Eighth page ($75)

4. Optional Silent Auction item donation?No   Yes (Thank you!)

Description:  "Donated by" tag:

Approximate value: Under $10 $10 - $25 $25 - $50 $50 - $75 $75 - $100 $100 and up Priceless / Don't Know   Will youbring or ship (by 4/20 please) this?

Thank you.  Within the next few business days, you will receive a confirmation email listing your above selections and any additional necessary registration information.