2005 USFCA Annual Conference & AGM

Registration Form

Portland Fencing Center - Westbrook, Maine

June 3 - 5, 2005

Registration Form: (Print and send with payment)

(print clearly)

Name: ___________________________

Address: ____________________ _____

City: _____________________________ State: ______ Zip: ________

Area Code and Phone: _____________________________

E-mail: __________________________________________

USFCA Title:  Associate ___  Moniteur ___  Prevost ___  Fencing Master ___  Non-member ___

Full 3 Day Conference:

Members $100 

Non-Members $120 

$________ 

$________ 

Per day rate:

Members $35 (x __ days) 

Non-Members $45 (x __ days) 

Circle days attending below:

Fri.(6/3)   Sat. (6/4)   Sun.(6/5)

$________  

$________ 

Total:

$ ________ 

Please make checks payable to "USFCA"

Please make your pre-registration payments to the USFCA by May 30,2005.

Mail Registration Form and payment to:

Anthony Gillham

USFCA Treasurer

11946 W. Mill Road #7

Milwaukee, WI 53225

Membership forms for the USFCA can be obtained on-line at www.usfca.org.