Registration Form

Name(s)_________________________________________________________

Address_________________________________________________________

City_____________________________ State ______Zip___________________

Phone_____________________ Fax______________________

E-mail________________________________________

If flying in: Arrival Date__________ETA_______N#_________

                                                                                                                                                                                                                                                                                                     
Basic Registration (Not including hotel accommodations): $ 60.00
(Safety seminar, hospitality suite three days, ground transportation, meetings and Saturday awards luncheon) 

Basic Registration	Number____	@ $60 =	$______
Saturday Awards Luncheon & Morning Meeting Only	Number____	@ $30 =	$______
Options
Lunch Cruise on Lake Queen	Number____	@ $34 =	$______
Mickey Gilley Show	Number____	@ $25 =	$______
Add - If registering After April 15th	Number____	@ $10 =	$______
		Total	$______

                                                                                                                                                                                                                                                            

Send registration form with check or credit card information below to:  United States Pilots Association, 483 S. Kirkwood Rd., Suite 10, St. Louis, MO 63122. If paying by credit card, the registration form may be faxed to: (314) 843-5155. Or, if you would like to register at a secure site on the internet, go to www.uspilots.org.

Charge it!   M/C___ or VISA___ Card No._________________________ Exp.____ Signature____________________

For more information, call Jan Hoynacki at (417) 338-2225, email at jan@hoynacki.com or USPA at (314) 849-USPA.