Name_____________________________________ Phone______________
Spouse __________________________________
Mailing Address________________________________________________
City______________________ State__________ Zip________________
Email Address_________________________________________________Professional Affiliation (circle one) DPP / PPA / Non-Member
# Person (s) Program Selection By 1/15/02 After 01/15/02 Nonmember ____ Saturday Tony Sweet (w/lunch) $ 125.00 $150.00 $150.00 ____ Sunday Carl Leinbach (w/lunch)
$125.00 $150.00 $150.00 ____ Monday Clay Blackmore (w/lunch)
$125.00 $150.00 $150.00 ____ Three Days of Programming Includes Lunch
Daily and Awards Banquet on Sunday$ 199.00 $225.00 $ 235.00* ____ Spouse - One day (w/lunch) $ 75.00 $ 95.00 ____ Spouse - 3 Days (w/lunches & banquet) $ 90.00 $100.00 ____ Banquet only (per person) $49.00 $55.00 Menu
Selection (s)____ Flounder Stuffed w/ Crabmeat ____ NY Strip with Bleu Cheese Sauce
____ Vegetarian Selection* Any non-member 3 day registration includes DPP membership thru July 2002 TOTALS $ ________
$________
$_________