Convention Registration The Hotel Hershey, July 8-10, 2024PTA Membership Level* Active (Telephone Companies) Associate Please let us know whether you are an ACTIVE or ASSOCIATE member of PTA.Mandatory Company Fee Price: Company/Contact InformationCompany Name* Contact Person* First Last Phone*Email* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Registration FeesThe following fees apply. Anyone attending the convention MUST be registered through PTA. There is an additional one-time company fee of $50 for Associate Members. Registration Through 6/3 Registration After 6/3 Dinner# (Prices include tax & gratuity) Golf Representative - $175 Representative - $200 MONDAY: Adults - $80.00 $205/golfer (includes lunch at course) Spouse - $75 Spouse - $100 Buffet (under age 9) ($40) Others 18 and over - $75 Others 18 and over - $100 Hamburger Meal ($35) Children under 18 - FREE Children under 18 - FREE Chicken Strips Meal ($35) #Monday Buffet menu is located on convention page under CONVENTION INFORMATIONNumber of RegistrantsHow many people would you like to register?*12345Registrant #1Name* First Last Registration Type*Choose...Representative - $200Spouse - $100Others 18 and over $100Child Under 18 - FREEHersheyPark Day*NO THANKSSign Me UpChild 2 and underPlease make a selection. Tickets are free to registered guests. Hersheypark Day also includes a luncheon. Deadline: 6/23Monday DinnerChoose...Monday Dinner Buffet - Adult - $80Child A (Jr. Buffet - must be under age 9) - $40Child B (Hamburger Meal) - $35Child C (Chicken Strips Meal) - $35I have a special dietary need. Yes, please contact me. If you have special dietary needs, we will gladly contact you for further details.JSR Memorial Golf Scramble Yes - $205 No Golf Handicap Registrant #2Name* First Last Registration Type*Choose...Representative - $200Spouse - $100Others 18 and over - $100Child Under 18 - FREEHersheyPark Day*NO THANKSSign Me UpChild 2 and underPlease make a selection. Tickets are free to registered guests. Hersheypark Day also includes a luncheon. Deadline: 6/23Monday DinnerChoose...Monday Dinner Buffet - Adult - $80Child A (Jr. Buffet - must be under age 9) - $40Child B (Hamburger Meal) - $35Child C (Chicken Strips Meal) - $35I have a special dietary need. Yes, please contact me. If you have special dietary needs, we will gladly contact you for further details.JSR Memorial Golf Scramble Yes - $205 No Golf Handicap Registrant #3Name* First Last Registration Type*Choose...Representative - $200Spouse - $100Others 18 and over - $100Child Under 18 - FREEHersheyPark Day*NO THANKSSign Me UpChild 2 and underPlease make a selection. Tickets are free to registered guests. Hersheypark Day also includes a luncheon. Deadline: 6/23Monday DinnerChoose...Monday Dinner Buffet - Adult - $80Child A (Jr. Buffet - must be under age 9) - $40Child B (Hamburger Meal) - $35Child C (Chicken Strips Meal) - $35I have a special dietary need. Yes, please contact me. If you have special dietary needs, we will gladly contact you for further details.JSR Memorial Golf Scramble Yes - $205 No Golf Handicap Registrant #4Name* First Last Registration Type*Choose...Representative - $200Spouse - $100Others 18 and over - $100Child Under 18 - FREEHersheyPark Day*NO THANKSSign Me UpChild 2 and underPlease make a selection. Tickets are free to registered guests. Hersheypark Day also includes a luncheon. Deadline: 6/23Monday DinnerChoose...Monday Dinner Buffet - Adult - $80Child A (Jr. Buffet - must be under age 9) - $40Child B (Hamburger Meal) - $35Child C (Chicken Strips Meal) - $35I have a special dietary need. Yes, please contact me. If you have special dietary needs, we will gladly contact you for further details.JSR Memorial Golf Scramble Yes - $205 No Golf Handicap Registrant #5Name* First Last Registration Type*Choose...Representative - $200Spouse - $100Others 18 and over - $100Child Under 18 - FREEHersheyPark Day*NO THANKSSign Me UpChild 2 and underPlease make a selection. Tickets are free to registered guests. Hersheypark Day also includes a luncheon. Deadline: 6/23Monday DinnerChoose...Monday Dinner Buffet - Adult - $80Child A - (Jr. Buffet - must be under age 9) - $40Child B (Hamburger Meal) - $35Child C (Chicken Strips Meal) - $35I have a special dietary need. Yes, please contact me. If you have special dietary needs, we will gladly contact you for further details.JSR Memorial Golf Scramble Yes - $205 No Golf Handicap Payment InformationMethod of Payment Please choose your method of payment below. All payments are due no later than 6/24/2024. No refunds after 6/24/2024. Cancellations prior to 6/24/24 will be refunded, LESS a $35 administrative fee.Payment Method* Check (send by 6/24/2024) Credit Card (those paying by credit card will receive an invoice from PTA along with payment instructions) Checks should be made payable to: Pennsylvania Telephone Association Mail to: 30 N. Third Street, Suite 780, Harrisburg, PA 17101 Questions call 717-238-8311Exhibit Space Reservation - FULLTables measuring 6’ in length will be available. Each table will be provided with an exhibitor identification sign. If your exhibit requires electric, please request it below. Exhibit Tables Quantity Price: $200.00 Quantity Will your table(s) require electricity? Yes No Electricity will cost an additional $25.Total Registration FeeTotal $0.00 CommentsThis field is for validation purposes and should be left unchanged.
