United Shoe Retailers Association
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United Shoe Retailers Association
United Shoe Retailers Association

Company Name:
Website:
Address:
City/State/Zip:
Phone:
Fax:
President/Owner
General Manager
Manager
Other
Your Name:
Email:

If different than company numbers:

Your phone:
Your Fax:
Arrival Date:
Departure:
Spouse
Sibling
Child
Parent
Friend
Co-Worker
Title:
Name:
Email:

If different from Attendee #1:

Address:
City/State/Zip :
Phone:
Fax:


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United Shoe Retailers Association
United Shoe Retailers Association

Company Name:

Single Occupancy
Non-Smoking
King
*Double Occupancy
Smoking
Two Doubles
* Pass thru pricing will apply
**Sunday (05/02/09) Arrival - an additional $205 plus tax will apply
**Monday (05/03/09) Arrival - an additional $205 plus tax will apply
**Friday (05/07/09) Departure - an additional $205 plus tax will apply


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United Shoe Retailers Association
United Shoe Retailers Association

Company Name:
MEMBER
$495 Single Occupancy
$595 Double Occupancy
NON-MEMBER
$595 Single Occupancy
$695 Double Occupancy
YES!! SIGN ME UP AS A USRA MEMBER
PLEASE ADD THE $95 MEMBERSHIP FEE & I’LL PAY MEMBER PRICES!!

$590 Membership + Single Occupancy
$690 Membership + Double Occupancy
Total Enclosed$
Check payable to: USRA
Mastercard
Visa
Amx
Name:
Card Number:
Exp Date:
Security Code:
On Visa, MasterCard and Discover the security code is the three digits to the right of the credit card number in the signature area on back of the card.    On American Express, the security is four digits printed (not embossed) on the right front of the card above the credit card number.
Credit Card Billing Address:
Same as listed above
See Below


Address:
City/State/Zip:


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