Registration Form Buffalo, New York • May 16 20, 2012 Adam’s Mark, 120 Church Street, Buffalo, ny 14202 1-716-845-5100




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National Garden Clubs, Inc. 83rd Annual Convention

Full-Time Package Plan Registration Form

Buffalo, New York • May 16 - 20, 2012

Adam’s Mark, 120 Church Street, Buffalo, NY 14202 1-716-845-5100

You must contact the hotel directly to make your room reservation

(Please type or print ALL information)

Last Name_________________________________ First Name _____________________________

Name for badge______________________________________________

Address _________________________________________________________________________

City___________________________________State___________Zip__________Country________

Phone___________________________ E-mail __________________________________________



Please check ___ if we can e-mail your acknowledgement. Be sure you have given your e-mail address.

State Garden Club _____________________________________________Region _______________

If any of the following designations apply for 2011-2013, please check: NGC Elected Officer________

NGC Appointed Officer____ NGC Board Member____ Regional Director____ State President________

International Affiliate_____NGC Life Member #_____________New NGC Life Member since 2011_____

Registration Fees (Required) to be received by April 16, 2012

Package Plan with five meals and $40 registration $265 $_____­__

Package Plan NY and Ohio Residents with five meals and $10 registration $235 $______­­_

Package Plan includes: May 18 - Opening Luncheon and Design Banquet

May 19 - Regional Breakfast, Saturday Luncheon and Awards Banquet



Optional Meal Events:

May 16 - Lunch-Finance, PH & E and Organization Study Committees $ 26 $_______

May 17 - Lunch-Executive and Flower Show Committees $ 26 $_______

May 17 - Life Member Banquet - NGC Life Members/NFA Members $ 55 $_______

- Guests $ 65 $_______

May 18 - Breakfast-Regional Directors and State Presidents $ 35 $_______



Late fee after April 16, 2012 $ 50 $_______

Total Registration and Meals $_______

Total Tours (from Tour Registration Form) $_______

(Please include your Tour Registration Form) Grand Total $_______

Mail Registration Form(s) and check payable to NGC 2012 Convention to Monica C. Hansen,

Registrar, 21 Henning Drive, Orchard Park, NY 14127-2816 • 716-667-1434 johnmonica@verizon.net

International Affiliates: For questions or concerns please contact Linda Herraez at linenrherr@aol.com

716-652-2488

No Walk-Ins will be accepted • No Registrations accepted by phone or E-Mail • No refunds after April 30, 2012

NOTE: Please indicate any dietary restrictions due to allergies or for medical reasons ______________________________________________________________________________



Registration by Credit Card is available ONLY to International Affiliates

Card type: Visa #________________________MasterCard#_____________________________

Expiration date: ___________________Three digit security code (on back of credit card): ________

Name on card (please print):_______________________________________________________

Total amount (10% service fee will be added): __________________________________________

Signature: _____________________________________________________________________



Send this information with your Registration form(s) to NGC 2012 Convention Registrar,

Monica C. Hansen, 21 Henning Drive, Orchard Park, New York 14127-2816


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