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Gregath Company,
Incorporated |
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Registration Closed
Information provided here
will be used for ongoing PR so please send this in with payment ASAP.
Please
send form and payment to:
Gregath Co., BOX 505, Wyandotte, OK 74370.
Name: ___________________________________________________________________________
Address: _________________________________________________________________________
Phone
Number:_______________________________ 
Preferred Roommates (optional): _____________________________________________________________________________________________
_____________________________________________________________________________________________
______ I am handicapped (for dorm reservation purposes only)
Email: ________________________________
Website: ________________________________
(___) Yes! You may use my Web contact information online and in the Syllabus.
(___) NO Do Not use my Web contact information online and in the Syllabus.
Speaking Topic/Requested Time Period - 1 hour before Q&A minimum (i.e. 1.5hr, 2hr, etc.): _____________________________________________________________________________________________
Presentation Equipment Requested:
_____________________________________________________________________________________________
Comments:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Please also include biographical information and a photo.
Prices include Speaker Discount
____ Standard Full Retreat Package @ $125.00 each = $______________
____ 5 person room accommodation supplement @ $10.00 each = $______________
____ Quad (4 person) accommodation supplement @ $21.00 each = $______________
____ Triple (3 person) accommodation supplement @ $42.00 each = $______________
____ Double (2 person) accommodation supplement @ $84.00 each = $______________
____ Single (person) accommodation supplement @ $210.00 each = $______________
Total (per person) Enclosed = $______________
Until October 1, 2005 - as available
____ Day Tripper (1 day) Offer @ $55.00 each = $_______________
Until October 1, 2005 - as available
NO
SHIPPING OR HANDLING FEES NEEDED
Page Last Updated:
April 13, 2012
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