Event Registration

Firm Name:
Position/Title:
Last Name:
First Name:
Mailing Address:
City/State/Zip Code:
Office Phone #:
Fax #:
Email Address:
Is your org. a designated 501 (c) 3?



Please check options that apply:







Brief Description:

Registration Fee (no cost to non profit assoc.)

Summit hotel rooms available at conference rate of $109/night.

Please contact the hotel directly to make a room reservation

$75.00 cost for dinner if you are not a non profit

Please make checks payable to FMCRC

One (1) Free Room Per Not for Profit Organization

If requesting a free hotel room please select a night below and then fax a copy of your

501 (c) 3 letter to: 1-813-915-5101 (please be sure to dial the "1" before the area code)

Please Check One Night:



*Cancellation Policy - please note, if cancelling, you must contact hotel directly on or before June 6th by 5 p.m. EST to cancel your room reservations, or else your credit charge will still be processed.

Number Awards Gala Seat(s) needed:
Names of Awards Gala Attendees: