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The PHYLAXIS SOCIETY PO Box 5675 Albuquerque, NM 87185-5675

Return Service Requested

NONPROFIT ORG. US POSTAGE PAID SAN BERNARDINO, CA PERMIT NO. 3021

FLORIDA

IN 2011

CONVENTION REGISTRATION

2011 SOUVENIR JOURNAL AD FORM

HISTORIC PHYLAXIS 38th /PHYLLIS 28th ANNUAL SESSIONS SHERATON SUITES HOTEL TAMPA AIRPORT WESTSHORE 4400 CYPRESS STREET TAMPA, FL 33607 Phone 813-357- 6145 MAIN DATES MARCH 3 THRU 5, 2011 BOARD OF DIRECTORS MEET MARCH 2, 2011

MAKE HOTEL RESERVATIONS DIRECTLY WITH THE HOTEL HOTEL CUTOFF DATE IS FEBRUARY 14, 2011 LIMITED ACOMMODATIONS - PLEASE RESERVE ROOMS EARLY THE COST FOR SINGLE OR DOUBLE OCCUPANCY IS: $89.00 PER ROOM PER NIGHT (TAX INCLUDED)

Historic 38th Phylaxis Society / 28th Phyllis Chapter

ANNUAL SESSION

Hon. John B. Williams, President, The Phylaxis Society Hon. Alfreda Brumfield, President, The Phyllis Chapter DEADLINE: February 11, 2011

Please submit CAMERA READY Artwork/Copy along with your remittance. Attach a hard copy your journal ad exactly as you wish it to appear. Submit a journal ad form for each 8 ½ x 11 page or partial page submitted for approval.

Name

P h o n e ( _ _ _ _ ) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Email Address

____________________________________________________________

Advertiser Name(s)

NAME

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ C I T Y _ _ _ _ _ _ ADDRESS _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ S T A T E _ _ _ _ _ _ _ _ _ _ _ _ _ _ Z I P _ _ _ _ _ _ _ _ _ _ _ _ _ _ TELEPHONE _ _ _ _ _ _ E-MAIL _ _ _ _

_____________________ PHYLLIS MEMBERS: AUXILIARY NAME

_ _ _ _ _ _ _________________________________________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Total Amount Enclosed $

Full Page Half Page Quarter Page Patrons

With photo $100 With photo $60 Without photo $50 Business card $20

Indicate the NUMBER of ADS below:

ADVANCE REGISTRATION SATURDAY REGISTRATION LATE REGISTRATION THURSDAY BUS TOUR Total

___ ___ ___ ___

$ 90.00

$ 70.00 (Registration, Luncheon & Banquet) $ 115.00 (After February 15, 2011) $ 10.00 $____________

ADDITIONAL TICKETS: Luncheon $30.00, Banquet $40.00 Luncheon: (#Fri) ________ (#Sat) _______ Banquet ________

Total $

______________

x x x x x

x x x

All Paid Full Page Ads will receive Complimentary Souvenir Journal

All ads are to be camera ready. Ad measurements are based on an 8 ½ x 11 page size. Black & white or color photographs accepted (black & white preferred). Ads will appear in black & white You may wish to use one of the following fonts for your ad copy Bookman, Courier, or Times Roman Payment for all ads or patrons must be in check, money orders, cashier’s, certified or company checks. ). Money orders, cashier’s, certified or company checks should be made payable to The Phylaxis Society and must accompany the ad(s) or patron(s). Mail Ads to: Hon. Robert N. Campbell, FPS. Attention: Souvenir Journal P.O. Box 480822, Kansas City, MO 64148-0822. Electronic Submissions can be emailed to rcam33@sbcglobal.net Question on Souvenir Journal, Contact Hon. Robert N. Campbell at 816-210-5012

Make checks payable to:

The Phylaxis Society

MAIL REGISTRATION FORM TO:

The Phylaxis Society PO Box 5675 Albuquerque, NM 87185-5675

FOR COMMITTEE USE ONLY: Form of Payment:

Amount Received:

Date Received:

Received By (initials)

Disc Rec’d: Yes or No

Ad Size: Full, Half, Quarter

Photo: Yes or No

Type: B/W or Color

Description:

Requests for registration refunds MUST be in writing and must be received at the address above no later than February 25, 2011.

Find these forms at: http://thephylaxis.org/phylaxis/conv_2011.php

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