NYSAVS
CONVENTION AND SHOW
REGISTRATION FORM
October 20- 22, 2011
Please check all that apply (one form per person) :
Exhibitor___ Individual Member___ Life Member___ Board Member___
Commercial Member___ Hon. Life Member___ Judge___
Please Print:
Name ______________________________________Phone ( _______ )______________

Address___________________________________________________

City ______________________ State/Prov. _____________ Zip _______

E-mail address __________________________

Name to go on Badge _________________________________________
In case of emergency, who should be notified:
Name _____________________________ Relationship ________ Phone# ( ___ ) __________
Registration Fees:
NYSAVS Member (by deadline) $25.00................................. ______
Non member (by deadline) $30.00 .......................................... ______
After 10/15, add $10.00 late fee $10.00 .................................. ______
Meals:
Friday dinner (circle one) $25.00 ............................................. ______
__ Chicken French
__ London Broil
__ Vegetarian Lasagna

Commercial Breakfast (Commercial members) from menu ______

Saturday Luncheon $19.50 ............................................. ______
__ Deli Buffet


Saturday Banquet (Circle one) $30.00
__ Grilled Salmon ...................................................................... ________
__ Sirloin Filet........................................................................ ________
__ Vegetarian Strudel...................................................................... _______

Total Enclosed ......................................................................... $ ______

Following receipt, you will receive confirmation.
Make checks payable to NYSAVS in U.S. Funds. Send this form (or a
photocopy) with payment to:
Irwin Wagman, 2470 East Ave., Apt 607, Rocester, NY,
14610.
Deadline: October 10, 2011 Registrations must be postmarked by the deadline
date to receive the lower registration fee. A $10 service fee will be
imposed on refunds after this date. No refunds after October 18, 2011
Persons with special dietary requirements should make them known when
submitting reservations. Special dietary needs cannot be accommodated after 10/15.