Wufoo

Attendee Name * First Last
Name to appear on nametag (if different) First Last
Company Name *
Mailing Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country

Please enter the address where you want any convention information to be mailed.
Phone Number * ### - ### - ####
Email *
Emergency Contact Name * First Last
Please list a person who will not be attending the convention with you.
Emergency Contact Phone Number * ### - ### - ####
Guest Name First Last
Name to appear on nametag (if different) First Last
Additional Guests

Please include ages for all children attending.
Registration Fee
Registration Type *
Single - $325 Couple/Family - $600 CLC Single - $275 CLC Couple/Family - $550 AGC Staff Person
Room Reservation

All rooms are reserved on a first come first served basis. Your hotel room will be reserved for you by AGC. All rooms are non-smoking rooms. The room rate is $177.79. Room fees are paid by the attendee to the hotel at check-out.
Arrival Date * MM / DD / YYYY
Departure Date * MM / DD / YYYY
Room Type *
King Double Special Request (please detail below) I do not need a room
Special Room Request

Please note that special requests may result in a higher room rate. If you are making a special request, you will be contacted with information on availability and room rate before your room is booked.
Number Attending Dinner at The Ocean Club

Please limit Ocean Club attendance to 1 per single registration or 2 for couple/family registration. AGC reserves the right to bill additional dinner guests at the rate of $50/per. We will be providing babysitting at the hotel, free of charge.
Number Attending the Saturday Brunch
Do Not Fill This Out

Wufoo

Registration Fee

Room Reservation