Personal Submersibles Organization

2004 PSUBS Convention
Registration Form
(See http://www.psubs.org/convention/2004/ for Convention details)

Registration:
Name:________________________________
Address:_____________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
Phone Number:_______________________________
E-Mail:_____________________________________
How many staying at the Courtyard at Marriot in Hillsboro, Oregon (for informational purposes only):_____________

Bringing Sub:

YES

1ATM

Ambient

Name:_____________________________

T-Shirts*
Size	Quantity
XXL	________
XL	________
L	________
M	________
S	________
Total Quantity	________

* T-Shirts are optional. Calculate costs in next table.

Costs**
Items	Quantity	Cost	Total
Friday, 20 August 2004 Field Trip to Naval Undersea Museum in Keyport, Washington***	________	$30 USD per person	____________
Saturday, 21 August 2004 Conference in Hillsboro, Oregon	________	$50 USD per person	____________
Saturday, 21 August 2004 Dinner at The Old Spaghetti Factory in Hillsboro, Oregon	________	Dutch	Dutch
Hats	________	$15 USD per Hat	____________
T-Shirts	________	$10 USD per T-Shirt	____________
Shoulder Patch	________	$5 USD per Shoulder Patch	____________
		Total	$____________

** Two week cancellation notice is required for full refund.

*** In the event that the trip to the Naval Undersea Museum
does not pan out, a Meet and Greet Picnic will be held instead. The cost will be
$10 each with the balance of $20 each being refunded.

Payment:

Send check or money order made out to Ray Keefer to:

Ray Keefer
PO Box 586
Gaston, OR 97119

Rev 2.2 05 Aug 2004 rk