PAY BY CHECK OR CREDIT CARD TO:
ANPA, INC.
4000 14th Street, Suite 401
Riverside, CA 92501-4010
Phone: 909-780-2504
Fax: 909-780-8083
ATTENTION !
EXTREMELY IMPORTANT ! ! !
Indicate Attendance -- Add Up Cost -- Send in Payment --
DEADLINE 5/30/99
DATE
EVENT
PHYSICIANS
OTHERS
ATTEND
# of PEOPLE
COST
6/23/99
Reception
FREE
FREE
YES or NO
$0
6/24/99
Coffee Break
FREE
FREE
YES or NO
$0
6/24/99
Luncheon
FREE
$25/person
YES or NO
6/25/99
Coffee Break
FREE
FREE
YES or NO
$0
6/25/99
Luncheon
FREE
$20/person
YES or NO
6/26/99
Health Check
FREE
FREE
YES or NO
$0
6/26/99
Annual Banquet
$50/person
$50/person
YES or NO
6/26/99
Health Check
FREE
FREE
YES or NO
$0
Childcare
$8/per child/hr**
YES or NO
** Please note that Las Vegas law does not
allow corporate babysitting **
However, ANPA Auxiliary has identified a group
that you can contract with on a private basis.
Below is the information:
Pleasant Baptist Missionary Church
Senior Pastor: Rev. Terry Cox
Contact Person: Mr. Beverly
Phone: 702-648-1645
Fax: 702-646-7578
Pay to the
Service
Provider
Lake Mead
If registering by credit card, complete the following:
t
t
Amount ______________ Exp. Date: _______
Card #___________-_____________-____________-____________
Signature: ______________________________________________
