Registration for 2001 TPAA Midwest Chapter Meeting
Oak Brook Hills Resort, Oak Brook, Illinois
August 31 – September 3, 2001
Member
Name: (English)______________________________ (Thai)_________________________
Spouse
Name: (English)______________________________
(Thai)_________________________
Children
Name: 1.
________________________________________ Age___ Male___ Female___
2.
_______________________________________ Age___ Male___ Female___
3.
_______________________________________ Age___ Male___ Female___
Address:
_______________________________City ______________ State_____ Zip___________
Telephone:
Home_____________________ Office________________ Fax ____________________
Medical
School: ____________________________________________Year of Graduation: ________
Registration
Fee: $75/family
$ 75.00
Dinner:
Adult Dinner (Saturday & Sunday)
$95.00x__ = $_____
Youth
Dinner (Saturday & Sunday)
$75.00x__ = $_____
Choice of Dinner on Sunday: Beef ___ Vegetarian ___ Fish___
Golf
Fee:
=
$_____
Tennis
Fee:
= $_____
Great
America (Saturday)
=
$_____
Disney
Quest (Sunday)
= $_____
Grand
Total
= $_____
Amount Enclosed
= $_____
Please Make check payable to TPAA Midwest Chapter and mail to:
TPAA Midwest Chapter
6992 Fieldstone Dr.
Burr Ridge, IL 60521
Deadline for registration: August 10, 2001
Please make room reservation directly to Oak Brook Hill Resort (special room rate for TPAA meeting)