| 2008 Memorials Registration & Fees |
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May 23-27, 2008Print this form (click on the Print icon at the right), fill it out, and return it to us (see instructions at the bottom). DESERT ROSE BAHA’I INSTITUTE • 1950 W. Wm Sears Dr • Eloy, AZ 85231 Ph: 520-466-7961 Fax: 520-466-7984 www.drbi.org Please print all information. LAST name: _______________________ FIRST name: ____________________ M ___ F ___ Address: ____________________________________________________________________ City: _________________________ State: _____ Zip: _________ E-mail: _______________________________________ Phone _________________________ Last Name First Name M / F Age if under 21 _______________________________ _______________________________ ____ _______ _______________________________ _______________________________ ____ _______ _______________________________ _______________________________ ____ _______ _______________________________ _______________________________ ____ _______ Special Meal Requirements? ___________________________________________________
Registration Fees: (Sat. breakfast through Sun. lunch and Fri. & Sat. & Sun. nights dorm lodging): 12 - adult - each $195 X _____ = $ _____ 5-11 yrs - each $130 X _____ = $ _____ 2-4 yrs - each $70 X _____ = $ _____ TOTAL $______ Commuter Fees: (with meals) 12 - adult - each $150 X _____ = $ _____ 5-11 yrs - each $90 X _____ = $ _____ 2-4 yrs - each $40 X _____ = $ _____ TOTAL $______
Commuter Fees: (without meals) 12 - adult - each $85 X _____ = $ _____ 5-11 yrs - each $50 X _____ = $ _____ 2-4 yrs - each $30 X _____ = $ _____ TOTAL $______
Day Rate: (Sat. and/or Sun. only with meals) 12 - adult - each $80 X _____ = $ _____ 5-11 yrs - each $40 X _____ = $ _____ 2-4 yrs - each $20 X _____ = $ _____ TOTAL $______
Day Rate: (Sat. and/or Sun. only without meals) 12 - adult - each $55 X _____ = $ _____ 5-11 yrs - each $25 X _____ = $ _____ 2-4 yrs - each $10 X _____ = $ _____ TOTAL $______
_____ Check/MO (Make payable to DRBI) Credit Card (Print Name as it appears on Credit Card): ______________________________ _____ Visa _____ MasterCard Expiration Date: _______________ cc #_____________________________________________________ ___________________________________________ Date __________ Signature of Cardholder *Add $10 per person after May 19, 2008 deadline. Mail your check/MO with this completed form or, fax this form to 520-466-7984, or call DRBI with your information. |