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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

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