Register: Fax/Mail/E-Mail/Phone


Fax/Mail Registration Form: SGA Workshop - 2018


Complete the form below and fax, e-mail, or mail it to:  ICSA, PO Box 2265, Bonita Springs, FL 34133.  Fax: 1-305-393-8193. E-Mail:  mail@icsamail.com

Name(s):

Address:

City: State: Zip:

Country:

Phone(s)/Fax:

E-mail:

Payment: [    ] Check            [        ] Visa            [     ] Mastercard

CC number: 

CC expiration date:

Use the table below to calculate the amount due. All rates are per person and include meals (Friday dinner through Sunday lunch) and Friday and Saturday accommodations. If you have questions, contact ICSA at (239)-514-3081 or mail@icsamail.com.

ICSA Members may deduct $25. Non-members receive an introductory Web membership with registration fee

No. People Status Register by  2/1/18 Register After  2/1/18 Adjustments Amount
  Double Occupancy $350 $400  
  Single Occupancy $425 $450  
     Member Deduction 
     Contribution 
     Total Amount Enclosed 

Double Occupancy

If you have a roommate, please tell us his/her name?
Do you want us to assign you a roommate?    Yes   [      ]       No   [      ]

Group Info

What is the name of the group you belonged to (for each registrant)?

How long have you been out of the group?