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2011 Seminar Registration Form

PLEASE PRINT CLEARLY

Name(s): ______________________________________________________________________
   
  ______________________________________________________________________
   
  ______________________________________________________________________
   
Telephone Number: ______________________________________________________________________
   
Email Address: ______________________________________________________________________
   
_______________ Members at $42.00 (includes lunch) ______________________________
     
_______________ Non-Members at $47.00 (includes lunch) ______________________________
     
Total enclosed: ______________________________

Persons paying after 5 February 2011 or at the door will be charged $50.00 (includes lunch).
Registrations must be received by February 5th for the advanced price.  Requests for refunds will be honored thru February 5th.

Please print this page and mail with your check payable to Pinellas Genealogy Society to:

Beth Shields, PGS Seminar Registration
11660 68th Ave
Seminole, FL 33772

Confirmation of registration will be delivered by email or an enclosed SASE.

Name: __________________________________________________
                    Select one
__________ Turkey with Swiss cheese on whole wheat
__________ Ham with cheddar cheese on whole wheat