St. Jude Medical Pacemakers & ICDs

Social Weekend Registration Form



Please print this page and mail a completed copy to the club with your check or money order.  

Pacemaker Club Inc.
P.O. Box 471, Station A
Fredericton, New Brunswick, Canada
E3B 4Z9


Item

Number of People

Registration Fee 
(US $)

Total
(US $)

Names of Attendees

Social Weekend Registration Fee 
(Sep 25 - 27, 2009 at Sheraton Riverwalk Hotel, Tampa, Florida)

 

$50.00 per person

 

 

 

 

 

 

Registration Information:

Name _______________________________

Street _______________________________

City _________________________________

State ________________________________

Country ______________________________

ZIP Code _____________________________

 

We may have questions so please provide your following contact information:

Name _______________________________

Email _______________________________

Username ___________________________

 

Terms & Conditions:

1) Money orders are required for all orders outside North America.
2) Make your check or money order payable to the "Pacemaker Club Inc"
3) All checks and money orders must be redeemable outside the USA.
4) The prices listed above are in US dollars.



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