United Shoe Retailers Association

RETAILER APPLICATION
Package 2

MEMBER

$745 Single Occupancy

$845 Double Occupancy

NON-MEMBER

$895 Single Occupancy

$995 Double Occupancy

YES!! SIGN ME UP AS A USRA MEMBER
PLEASE ADD THE $95 MEMBERSHIP FEE & I’LL PAY MEMBER PRICES!!

$840 Membership + Single Occupancy

$940 Membership + Double Occupancy

Single Occupancy

Non-Smoking

King

*Double Occupancy
**Pass thru pricing will apply

Smoking

Two Doubles

**Friday (05/02/08) Arrival - an additional $179 plus tax will apply
**We must have a credit card on fileHotel will bill your credit card directly for additional nights72 hour cancellation required or your card will be charged by the hotel

Total Enclosed:

Method of Payment:

Check payable to: USRA

Mastercard

Visa

Name:

Card #:

Expiration Date:

Signature:

Year Open

Years in Business

Indoor Mall

Outdoor Mall

Strip Center

Free-Standing

Web Site

Men's

Women's

Men's/Women's

Specialty

Number of Employees

Low to moderate (up to $50)

Moderate ($50 - $150)

Moderate to High ($150-$300)

Over $300

Mrs

Name:

Email:

Store Name:

Website:

Address:

City/State/Zip:

Phone:

Fax:

Arrival Date:

Departure Date:

Mrs

Spouse

Sibling

Child

Parent

Friend

Co-Worker

Name:

Email:

If different from Attendee #1

Store Name:

Address:

City/State/Zip:

Phone:

Fax:

Arrival Date:

Departure Date: