United Shoe Retailers Association
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United Shoe Retailers Association

ROOM 1

Company Name:
Website:
Address:
City/State/Zip:
Phone:
Fax:
President
VP
National Sales Manager
Sales Rep
Your Name:
Email:

If different than company numbers:

Your Address:
City/State/Zip :
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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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
**Saturday (05/07/09) Departure - an additional $205 plus tax will apply


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United Shoe Retailers Association

ROOM 2

Company Name:
Website:
Address:
City/State/Zip:
Phone:
Fax:
President
VP
National Sales Manager
Sales Rep
Your Name:
Email:

If different than company numbers:

Your Address:
City/State/Zip :
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:


Back
Next Page
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 (05/09/09) Departure - an additional $205 plus tax will apply


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Company Name:
Amount Enclosed $:
Visa
Mastercard
PayPal
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:
**We must have a credit card on file to guarantee your room for additional nights
USRA will not use this card unless instructed to do so
72 hour cancellation required or your card will be charged by the hotel


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