(PLEASE PRINT ALL INFORMATION CLEARLY)

Last Name _____________________First ____________________
Address ________________________________________________
City _______________________ State __________ Zip _________
Phone ( ) _____________ E-mail _________________________

                                                  Cost       Quantity                  Total
Registration ( before 9-1-09)           $ 20      ______ _                  _______
Registration ( after 9-1-09 )           $ 25      ______ _                  _______
At the Convention                          $ 30      ______ _                  _______

LIVE ENTERTAINMENT (Friday) $12.50    _______                   __ ________
Saturday (Show)                           TBA   ______ _                  _______
BANQUET                                   $ 25     ______ _                  _______
Newcomer Donation                                                                   ________
Grand Total Enclosed                                                 $ __________

PLEASE REGISTER EARLY BY MAIL OR AT FUND-RAISERS WITH THE WNYRCNA XIV REGISTRATION COMMITTEE MEMBERS ONLY. PLEASE MAIL FORM AND MAKE CHECK OR MONEY ORDER PAYABE TO: WNYRCNA XIV    P.O. Box 151 Buffalo, NY 14207                      

 (NO REFUNDS), Twenty dollar ($20) fee for all returned checks. No checks or credit cards accepted on site at the convention - Cash Only

( NO CHECKS AFTER 9-1-09)

Registration is Important: The money that is collected from registration is used to pay all convention related expenses. We believe once participants understand that the fee from registration makes the event possible and the registration funds
collected are used for the planning of the present and future conventions, then the reasons for registration should be clear. It is the support of each participant's
registration or donation that helps make our convention a success.