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VCFSEF Pre-Registration Form - Velo-Cardio-Facial Syndrome Educational Foundation’s (VCFS)

VCFSEF Pre-Registration Form

Pre-Registration Form

Seventh Annual Meeting

(Preregistration will be accepted until June 30, 2001)

Velo-Cardio-Facial Syndrome Educational

Foundation, Inc

July 20-22, 2001 – Deerfield Beach, FL

First, Middle, Last Name:
Address:
City, State, Zip/Province
Home Phone**: Work Phone**:
Fax: Email:
**Please include area code and extensions;

if not in U.S./Canada, include country & city code.
I am a member of the Foundation:     No   Yes:            Lay     

Professional

Note: If you are not a member, please print

out the dues form, and send it with your pre-registration and you will

receive the member’s registration fee. 

Accommodations: : TThe entire meeting will be held at the Hilton Deerfield Beach/Boca Raton Hotel. The hotel is close to both the Fort Lauderdale and Palm Beach airports and is also close to Boca Raton. All rooms are $75 (rate per room, not per person). Reservations should be made directly with the hotel or with Hilton International. Call 1-800-624-3606 or 1-800-HILTONS, you are attending the Velo-Cardio-Facial Syndrome Educational Foundation meeting. The hotel has a beautiful pool area, exercise facility, and restaurant. The beach is two miles away. Golf is readily available with 6 courses accessible to the hotel. Shopping at the Mizner Park is close to the hotel.

Registration Fees: Enclose check or money order. For registrations from

outside of the United States, please send a bank draft payable in U.S. dollars
Single preregistration, member $50.00 U.S.
Family

preregistration, 2 members (list names below)

 $70.00 U.S.
Single

preregistration, nonmember:

 $60.00 U.S.
Family

preregistration, 2 nonmembers (list names below)

 $90.00 U.S.
Family

preregistration, 3 or more members (list names below)

 $80.00 U.S.
Family

preregistration, 3 or more nonmembers (list names below)

 $100.00 U.S
Student

member preregistration

 $40.00 U.S.
Student

nonmember preregistration

 $50.00 U.S.
Optional

Friday Night Southwestern Buffet Dinner

 $30.00 U.S. per person

Total Enclosed:

$

Note: &nbsp:Please list all family members to be

registered below (family registrations only): 

Check: 

Interested in leg pain

 Interested in Speech Clinic
Interested in Sibling Workshop Interested in a teen/young adult get-together
Interested in child care during meeting Interested in

sharing a room

Please send completed form along with check or money order to:

Velo-Cardio-Facial Syndrome Educational Foundation

c/o Dr. Robert J. Shprintzen

C.D.U., 714 Jacobsen Hall

SUNY Health Science Center at Syracuse

750 East Adams St.

Syracuse, NY, 13210

  • Registration fee at the door will be an

    additional $10.00 per person, if space is available.

  • Send checks with completed form made payable

    to:

  • Receipts and certificate of attendance will be available at the conference.