Promoting the growth and expansion of home brewing & winemaking

Retailer Registration - 2010 FITA Conference

This form is for MAIL-IN or FAX-IN ONLY.
P. O. Box 1373, Valrico, FL 33595
Fax: 813-681-5625

SATURDAY, May 22 - MONDAY, May 24, 2010

Embassy Suites Hotel in Downtown Portland, Oregon

Company Name __________________________________________
Address ________________________________________________
________________________________________________
Phone No. ______________________________________________
E-mail address __________________________________________

Attendees (please list names individually and PRINT clearly and indicate first-time attendees with an "X")

____________________________________________________
____________________________________________________
____________________________________________________
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Fees listed below are PER PERSON

		No.	Total
MEMBERS & THEIR GUESTS (Dues must be current)	$110.00 USD (or equivalent)	___	_________

NON-MEMBER RETAILER	$135.00 USD (or equivalent)	___	_________
Portland City Tour Sat. morning	$65.00 pp - member $75.00 pp - non-member	___	_________
Home Brew Shop Visit (Sat evening)	There is no charge as we will be walking, but please let us know if you plan to join us and bring an umbrella!	___	________
	SUB-TOTAL		_________
	2010 Dues		________
PAYMENT - MINIMUM 50% DEPOSIT REQ'D			_________
BALANCE DUE AT REGISTRATION			_________

We accept checks, cash, or money orders. (sorry, no credit cards).

NOTE: Make checks payable to FITA mail to P.O. Box 1373, Valrico FL 33595
Or FAX this form to 813-681-5625.

REFUNDS - Full refund (less $10.00 USD processing fee) until 1 May 2010.

We take your privacy very seriously and we never sell, rent or otherwise distribute the information you submit. You can rest assured that your personal information, including your email address, will be kept in strict confidence.

WHOLESALERS/EXHIBITORS - please use wholesaler/exhibitor registration form.

Please note: 2010 dues must be paid to qualify for "Member" rates.