REGISTRATION FORM FOR 2005 FLORIDA DIVISION CONVENTION

Name (s) ____________________________________________________________________________

UNA Chapter/Organization  ______________________________________________________________

Address: ___________________________________________________________________________

Phone: ___________________________E-mail: __________________________

Chapter Delegate:                 Yes  ______             No  ________

Registration (includes lunch)   ________  x $35.00   =    ___________     
Guests lunches                  ________  x $20.00   =    ___________      
Nights at hotel (single)        ________  x $65.99   =    ___________
Nights at hotel (double)        ________  x $74.99   =    ___________
Note: Registration is due by April 14th and the check should be made payable to �UNA-USA Jacksonville� and sent to Gaye Feuer, 5841 Dickson Rd., Jacksonville, Fl 32211-4640. You may send one check prior to April 14 to the above address for the registration, guest lunches and hotel without the hotel tax or make a reservation directly with the hotel (Extended Stay America, Tel: 904 396-1777) and send only the convention registration/guest lunch fee to the above address; then you can pay the hotel by credit card but will have to pay the 13% hotel tax on those rates. For any questions please contact either Andy Bruck (904) 388-9334 or Steve Baker (904) 388-3531.

For convention updates please visit http:www.geocities.com/florida-una or http://users.ju.edu/sbaker/conv.htm

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