Carolinas Food Industry Council

Make checks payable to CFIC
You may register up to SIX on this form
To receive early-bird registration discount, submit by June 22
Cancellations
With full refund will be honored through July 13 (substitutions may be made without penalty
Cancellations received after July 13 will carry a $75 per person cancellation fee
Confirmations will be sent via fax/e-mail upon receipt of registration form
Badges and all other meeting materials will be distributed at the convention registration desk (Hilton Lobby)
Make sure to sign waiver below before submitting registration

Convention Registration Fees

	Early Rate (received before June 22)	Regular Rate (received after June 22)
Members of CFIC	$100	$125
Spouse/Guest	$75	$100
Yound Adult (13-21)	$75	$100
Children (12 and under)	Free	Free
Childrens Program (ages 5-12)	Free	Free

The registration fee covers: meals, carnival, education, entertainment, Snack Shack and Children's Program.


Suppliers: Check out Your Complimentary Registration Schedule Complimentary registrations for company representatives are tied to the three Associate Membership Dues Levels: . $5,000 Dues Level: Patron of Industry FIVE complimentary convention registrations for company reps Register an unlimited number of company reps for the convention Special Directory Recognition $1,000 Dues Level: Friend of the Industry Three complimentary convention registrations for company reps Register an unlimited number of company reps for the convention $500 Dues Level: Supporter of the Industry One company rep and this one is complimentary You may pay convention registration for any family members you choose to bring Membership is required to attend the Annual Convention: Supplier Membership Dues Invoice. REGISTRANTS

Registrant
Registrant
Registrant		Young Adult / Child Age
Registrant		Young Adult / Child Age
Registrant		Young Adult / Child Age
Registrant		Young Adult / Child Age
	Address
	City, State Zip	State Zip
	Phone (incuding area code)
	Fax
	*Email

REGISTRATION FEES
CFIC Member	# Attending			= $
Spouse/Guest	# Attending			= $
Young Adult (13-21)	# Attending			= $
Children (12 and under)	# Attending		Free	= Free
Total Payment To Charge:				= $

PAYMENT INFORMATION Make Checks Payable to Carolinas Food Industry Council
Payment Type
Credit Card Number
Name on Credit Card
Exp. Date				Do You Need a Receipt?

SPECIAL DIETARY AND/OR PHYSICAL NEEDS Please indicate if anyone in your party has special assistance (physical and/or dietary needs):
	Name of Guest:
	Special Need:

SOCIAL EVENT COUNT
Please specify the total number of people from your party who will attend each social event:
		# will attend Thursday evening Carolinas College Event (children invited)
		# will attend the Friday Family Carnival Night (children invited)
		# will attend the Saturday President’s Reception and Dinner (children under 16 not admitted to Saturday dinner)
		# will attend the Children's Program on Saturday Evening

COMPLIMENTARY CHILDREN'S PROGRAM (AGES 5-12)
Date: Saturday, July 24 (6:00 - 10:00 pm) Theme: "Sports Night" Fee: Complimentary NOTE: Children Age 4 at the time of the convention and younger are not eligible for the Children's Program.
Name Special Dietary Restriction Age
Name Special Dietary Restriction Age
Name Special Dietary Restriction Age
Name Special Dietary Restriction Age

Hotel Accommodations Are Still Available! Contact: Hilton Myrtle Beach directly (800) 876-0010 Reference the code: "CFO" and Carolinas Food Industry Council to secure the convention rate which ranges from $227 - $365 (plus tax).
WAIVER OF LIABILITY
The undersigned, in consideration of his/her registration at the 2010 Carolinas Food Industry Council Convention, releases, holds harmless and discharges the association, management staff and their agents, from any and all actions, claims and demands which may arise out of an accident, casualty or occurrence during said convention. Your signature below acknowledges acceptance of these provisions of registration for all those listed on this form.
Please type name in lieu of your signature:

If you would like to keep a copy of your records, PRINT the page first before SUBMITTING the form. You will receive confirmation information in July.