FIRST AMCANA MEET
CONFERENCE REGISTRATION FORM

September 3rd – 6th 2010, Wyndham Orlando Resort, 8001 International Drive, Orlando, Fl 32819

Phone 1 800 388 2632 Fax: 407-351-5016

Please call the hotel directly and make the reservations. Ask for "AMCANA" group rate for $69.00 for a double bed room and $89.00 for a suite.
 
Email Id:    
Last Name:   First Name:  
Year of Entry to AMC:     Address:
City:State:
Zip:Phone:  
SPOUSE
Last Name:First Name:
Year of Entry(if applicable):
Children (please include ages)
1) Age: 2) Age:
3) Age: 4) Age:
Registration Fees includes two dinners 4th and 5th, three breakfasts, full buffet 4th, 5th and 6th, CME and attendance at all the activities (Evening functions on 4th and 5th, nightly disco  + others.  Full programme follows).
By August 3 After August 3
Alumnus and spouse $300 $350
Alumnus only $200 $250
Resident in training/ Guest / Visitor $150X$175
Children 5 to 18 (Per Child)  $  60X$75
Children under five free
Total Amount:$
One time offer: REDUCED LIFE MEMBERSHIP                                   $ 150
Additional Donation(Grand Patron $5000.00 or more, Patron $2000.00 or more Benefactor $1000.00 or more Donor $500 or more.)                                                   $ 
Grand Total Amount:$
Note. 1.You may charge this amount by using CREDITCARD or PAYPAL Account please click paypal button below.

2.you may print and fill this form and mail the check. Checks should be made payable to Andhra medical college Alumni Association of North America (do not abbreviate to amcana on the check) and mail to AMCANA, 175 Peach Drive, East hills, NY 11576 .
 Visit our web site for additional info:www.amcana.com. You may call Babu Bangaru 212 263 7868/516 484 0279 bbangarumd@hotmail.com, Sriram Sonty 708 957 4302, 708 805 4501 ssonty@msn.com , Rajgopal Nandyala 405 285 2820 rajnandyal@aol.com, Uma Pushpavalli 701 795 9448, 701 330 1499 pavalli@msn.com. Annapoorna Pattisapu 407 425 1131,annipatt@aol.com or any other committee members on our web-site.