Register Online SPH&TS/UPHS Annual Convention 2019 Registration Form Ogden, Utah May 8-11, 2019 Name* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last Suffix Member NumberAddress* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Enter Email Confirm Email Membership Status*Check all that apply. SPH&TS Member UPHS Member Member of both SPH&TS and UPHS I am not a member of either society Former SP Employee Former/Current UP Employee Vendor First-Time Attendee Presenter Staff Registration & PricingIncludes one banquet ticket per registrant.Member/non-member registrationPrice increases to $170 beginning March 30, 2019. Price: $150.00 Quantity: Registrant banquet choice*Please choose:Prime RibChicken AlmondineVegetable LasagnaRegistrant #2 banquet choice (if applicable)*Please choose:Prime RibChicken AlmondineVegetable LasagnaDo you need additional banquet tickets?YesNoAdditional banquet tickets$40 each, for guests or commercial vendors. Guests attending the banquet will need a badge. Indicate a name for each ticket ordered.Guest #1 NameGuest #1 Entrée ChoicePlease choose:Prime RibChicken AlmondineVegetable LasagnaGuest #2 NameGuest #2 Entrée ChoicePlease choose:Prime RibChicken AlmondineVegetable LasagnaGuest #3 NameGuest #3 Entrée ChoicePlease choose:Prime RibChicken AlmondineVegetable LasagnaExtra Fare ItemsTo ensure the timely delivery of extra fare items, registration must be received before March 29, 2019Convention polo shirt w/pocketBlack polo shirt with pocket and Ogden logo. Price: $30.00 Quantity: Please select shirt size (all adult sizes) M L XL 2XL 3XL 4XL Convention mugWhite china with Ogden logo. Price: $10.00 Quantity: Extra Fare TicketsFriday, May 10, 2019 - Golden Spike National Historical Site Motor coach trip. Includes lunch. Available to paid registrants only. 1 guest allowed per registrant. $55 per person.Number of trip tickets with Turkey Sandwich Lunch Price: $55.00 Quantity: Number of trip tickets with Vegetarian Meal Price: $55.00 Quantity: Saturday, May 11, 2019 - Heber Valley RailroadMotor coach departs Ogden at 8 am. You will ride a charter train at 10 am. Train will be pulled by a diesel locomotive and will include photo opportunities and run-by. Train ride ends at 2 pm. Return to Ogden at 4 pm in time for the banquet that evening. Trip cost includes motor coach trip, train trip, and box lunch. Please bring additional snacks and bottled water. Limit 1 registrant and 1 guest (total of 2 tickets). Maximum of 50 attendees. $85 per person. Price: $85.00 Quantity: GRAND TOTAL $0.00 Requests for refunds on or after April 26, 2019, will be approved at the discretion of the SPH&TS Society.Credit Card* DiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name Please reassure us that you are human.