2012 Registration Form 4/3/2012 (00128860

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Mid-Atlantic Chapter
Event Registration
Dinner and/or Ghost Tour
The Mid-Atlantic Chapter has two events planned at the National Conference in New
Orleans on Tuesday, October 13. Registration deadline for both events is October 5.
First Event: Dinner at Dickie Brennan’s Bourbon House, 144 Bourbon St., New Orleans,
LA 70130, 504-522-0111. Dinner includes soup or salad, main course and dessert with
New Orleans cuisine. Attendees will have a choice of soup or salad (Seafood Gumbo or
House Romaine Salad) and a choice of dinner entrée (BBQ Shrimp or Creole Chicken).
Dessert is Banana Bread Pudding. A vegetarian option for dinner is available but must be
requested on the registration form below. A cash bar will be available.
There is no cost to Mid-Atlantic Chapter members and one guest and $20 for non-members
and additional guests.
Dinner is limited to the first 60 folks who register. Dinner begins at 5:45 pm on Tuesday,
October 13.
Second Event: Ghost Tour by Voodoo Bone Lady Haunted Tours, 201 St Charles Ave
#2560, New Orleans, LA 70170, 504-267-2040. Tour leaves at 8 pm from 701 Royal Street, a
short distance from our dinner at the Bourbon House. Cost is $25.99 per person. This is a
walking tour which will take approximately 2 hours.
Registration Form
Registrant Information – You can choose either event or both events. Please complete only for the
event(s) you will be attending.
Registrant:
Company:
Dinner at
Bourbon
House
Telephone:
Member: No charge
Guest of Member: No charge
Non-Member and additional guests: $20
per person
# of non-members/additional guests
attending: _______
E-mail address:
Dinner Choice: Please list total for dinner choice:
BBQ Shrimp: ____________
Creole Chicken: _________
Vegetarian meal requested: _____________
Total due for Non-member/additional guests
attending: (# above x 20 per person) $______
Dinner Choice
(Please
Chapter Member:
BBQ Shrimp:
choose for
Chapter
member and
all guests
and/or
nonmembers
(for additional
non-members
or guests
please use
another
Registration
form)
Ghost tour at
Voodoo Bone
Lady Haunted
Tours
Creole Chicken:
Name of Guest or Nonmember:
Vegetarian meal requested:
BBQ Shrimp:
__________________________
Creole Chicken:
Name of Guest or Nonmember:
Vegetarian meal requested:
BBQ Shrimp:
__________________________
Creole Chicken:
Vegetarian meal requested:
Cost: $25.99 per person
# of persons: ________________
Total due: $___________________
Payment by
Credit Card
Please access the AICP online registration at AICP online registration system and enter the required
information or provide the following information if mailing the registration form:
Credit Card Payment in the amount of: $___________________
Credit Card Type:
Visa
MasterCard
American Express
Card Number: _________________________ Expiration __________________
Name As it Appears on Card: _________________________________________
Name of Registrant(s): _______________________________________________
Payment
by check:
Mailing the
Registration
Form:
Signature: ____________________________________
Check enclosed
Date: ________________________
Please make the check payable to: AICP. If you are mailing a check, please see below for the address.
Please mail the registration form and your check to our secure AICP lockbox at:
AICP
AICP/Wells Fargo
P.O. Box 758938
Baltimore, MD 21275-8938
Questions? For questions on the Dinner event, contact Silje Roalsvik or Noel Valenti-Grammer. For questions on
the Ghost Tour, contact Sam Garro.
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