Registration Form

Use this form to register for the 1997 International COAI Convention. The convention will be held at the Sturbridge Host Hotel in Sturbridge, Massachusetts from April 15th through April 20, 1997. You will be contacted for payment information.

You may print this form and use the postal service to mail it to the South Shore Joeys. Mail information is at the bottom of this form.

NAME
Last Name:
First Name:
Middle Initial:
COAI Number:
Clown Names Used:
Alley Affiliation, if any:
ADDRESS
Address Line 1:
Address Line 2:
City:
State or Province:
Country:
Zip/Postal Code:
Telephone Number:
Email Address:
Your email address is very important. Please double-check it. This will ensure that we will be able to get in touch with you.

REGISTRATION INFORMATION
Full Registration	$85.00
Full registration includes: Theme Party, Banquet and Bon Voyage Breakfast Buffet. Theme Party is "Early America Comes Alive"
Registration After March 1, 1997	$90.00
Single Day Registration (no meals included)	$30.00
Theme Party Only (includes D. J. and Hors 'devours)	$20.00
Banquet Only	$30.00
Breakfast Only	$12.00
Day Trips Available
Old Sturbridge Village	$11.00
City Tour & Mall Outlet Store	$15.00
Hospital Visit in Clown	No Charge
Convention T-shirts ($12.00 each)
T-shirt Size	Quantity Ordered	Amount
Small
Medium
Large
XL
2X
3X
Total Amount Due:

MISCELLANEOUS INFORMATION
Preferred Method of Contact:	Snail Mail Email Telephone
Is this your first COAI Convention?	Yes No
Do you need interpretation for:	Spanish Sign Language
Additional Comments:
Continental is the official airlines for the 1997 Convention. To receive a 5% discount over the regular rate call for reservations using reference RE: Z Code: ZJWF Reference code: NRCESL. Flight destination choice between Bradley International or Worcester Airport. Call Continental today at (800) 468-7022. Click here to see the Area Map.
Room reservations can be made with the Sturbridge Host Hotel at (800) 582-3232.

Mail completed registration forms and check or money order to:
	South Shore Joeys' Convention '97
	Barbara "Barbie Doll" Kelleher
	581 Ashmont Street
	Dorchester, MA 02122
	(617) 282-3487

© Copyright 1988 - 1997 by Dana J. Montgomery. Copying of this web page in whole or in part (logo, images, text, etc.) is prohibited without express written permission of Dana J. Montgomery.
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