Name

Name on name tag

FFYR Position/Title

Address

City/State

Zip

Phone

E-mail

Local Club

Your position in club

Today's date

(e.g., Bob instead of Robert)

(If none put "member")

Note:

Terms of Agreement

(If none put "none" in box)

(If none put "none" in box)

* tax not included

Payment is due by November 2, 2009 by noon--we no longer guarantee that on site payments will be accepted. If you have not registered and paid by  November 2, 2009, we may not be able to place a food order, and you may not receive equal service. The FFYR reserves the right to refuse entrance and registration from anyone.  Non-FFYR members such as media, vendors and guests should contact us prior to registering for the event. 

Crowne Plaza

1601 Belvedere Road

West Palm Beach, FL 33406

(888) 689-6892  (ask for the "Young Republicans" rate of $79 per night)

www.CPWestPalmBeach.com

Active Member Online Registrations

Florida Federation of Young Republicans

Fall Convention

West Palm Beach, Florida

November 6 - 7, 2009

Member Registration Below

Signature:

This signature must be that of the individual "signing" this registration electronically or be made with the full knowledge and permission of the individual, otherwise it constitutes forgery under s.831.06, Florida Statutes.  By electronically signing this registration you enter into an agrement with the FFYR and agree with the Terms of Agreement.

Paid for by the Florida Federation of Young Republicans. Not authorized by any candidate's or candidate committee.

Web site powered by Dixie Strategies, LLC

Registration is a simple TWO step process

Step 1

(fill out the form below)

I have read and agree with the

Full Registration $59*Other (please use note box)