Testing New Convention Form - International Coleman Collectors Club

ICCC Convention Registration Form

Name *

First

Last

Membership Number *

ICCC membership number

Address *

IMPORTANT: Please enter your FULL postal address, including ZIP/Postcode and Country.

Email *

Confirm Email

Phone Number (primary) *

Phone Number (secondary)

This is my first ICCC convention *

Attendance *

Additional information

Please add the names of the other people in your party if you are attending as a couple or family.

Additional Late Fee $10 from June 1, 2021 *

I don't need to pay the late fee as I'm paying before June 1
I agree to pay the $10 late fee

I want to reserve the following number of 8’ sales tables (at $20 each) *

I want to reserve the following number of 8’ display tables (at no cost) *

I have a special requirement (please state)

I want to reserve the following places at the Friday Night Banquet ($35 per person standard meal) *

Friday Night Banquet at the Frank Fickett Scouting Center in Austin: Dinner will be buffet style and includes Chef Carved Roast Beef and 12 Spice Chicken. Additional menu items include: garden salad, buttered rosemary potatoes, green bean almandine, rolls & butter. Desert will be assorted mini cheesecakes and beverages are included. A vegetarian option is available (please reserve below).

I want to reserve the following places at the Friday Night Banquet ($35 per person vegetarian meal) *

Please indicate if you want to order the vegetarian meal instead. This is IN ADDITION to the number already ordered for the standard meal.

Payment Method *

I am paying by check in USD to ICCC
I am paying with PayPal to icccpaypal@intlccc.net and will add 5% to cover costs