Membership In the - Council of American Master Mariners
Membership In the - Council of American Master Mariners
Membership In the - Council of American Master Mariners
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Name: ____________________________________________________________CAMM <strong>Membership</strong> No. ______________<br />
Address: ______________________________________________________________________________________________<br />
City: __________________________________________________________ State: ___________ Zip: __________________<br />
Best Contact Phone: _____________________________________ Alternate Phone:_________________________________<br />
Email address: _________________________________________________________________________________________<br />
Name for ID badge: ____________________________ CAMM Chapter Affiliation: _________________________________<br />
Arrival Date: ___________________________________________ Departure Date: _________________________________<br />
Primary Attendee<br />
Guests<br />
BAY AREA<br />
SAN FRANCISCO<br />
CA M M AGM & P D C<br />
The <strong>Council</strong> <strong>of</strong> <strong>American</strong> <strong>Master</strong> <strong>Mariners</strong>, <strong>In</strong>c.<br />
Registration Form<br />
2013 Pr<strong>of</strong>essional Development Conference & Annual General Meeting<br />
April 24-26, 2013 � Oakland, CA USA<br />
Events (Put a check mark in <strong>the</strong> boxes you plan to attend)<br />
Wed. April 24 Thurs. April 25 Fri. April 26<br />
Welcome<br />
Reception<br />
No Charge<br />
Development<br />
Conference<br />
$65 / person<br />
Spouse &<br />
Guest Outing<br />
at<br />
meetings<br />
General<br />
Meeting<br />
$65 / person<br />
Please check if applicable:<br />
☐ I require special needs and/or assistance (please explain): ____________________________________________________<br />
____________________________________________________________________________________________________<br />
Please return this form with check payable to “CAMM SFBA” no later than March 1, 2013 to:<br />
Captain Klaus Niem<br />
CAMM SFBA Chapter<br />
4207 Chardonnay Ct.<br />
Napa, CA 94558-2562<br />
A fillable version <strong>of</strong> this form is also available on CAMM’s website:<br />
www.mastermariner.org/2013pdc-agm<br />
Gala Dinner<br />
$52 / person<br />
(please circle<br />
choice)<br />
Mahi Mahi<br />
Goat Cheese Ravioli<br />
Filet Mignon<br />
Mahi Mahi<br />
Goat Cheese Ravioli<br />
Filet Mignon<br />
Mahi Mahi<br />
Goat Cheese Ravioli<br />
Filet Mignon<br />
Grand Total Due<br />
TOTALS