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Updated - Aug 10,2021
Regional Registration Form
Northeast Ch apte r Falc on CLUB OF AMERI CA
PRESEN TS T HE   2 2
n d   AN NUA L
RE  GION A  L   F  A  L  CON MEE  T A ugu st 20 & 21, 2021 at th e C row n e Plaza Hot e l 801 Gre en w ich A v e ., W arwick, RI  02886 Meet an d Ban q ue t R egis t r a t io n F o r m Name : ______________ ____________________ ______Spou se/Gu es t: __________ ________________ A ddress: _______________________________________________   C ity :  _________ ______________ State : _________ _________   Zip: ________________    Ph on e : ( _ _ _ ___) ____________________ Falcon R eg i s t r a t io n I nf o r m a t i o n V ehicle Y e ar: ___ ____ __   Model :  ____ ____ _______ _ ______   Bod y Style: _ __ ___ __ ____ _______ Color : _ _ __ ___ _ __ ___ ___ En gi n e: __ _ __ ___ __ Sto ck: __ ___   Lt. Mod. __ _ ___  M odifie d ______ Fa l con Regis tr a t i o n F ee :  $ 20.0 0                                  1 @          $_______ ____ _ o r S p ecia l D ail y D r i ve r Cl a s s :  $1 5.00                         1 @           $ ____________ Banquet: Satur day Au gust 21, 2 021 at 6:00 p m ______ @ $3 6.0 $                        . Stuf fed B oneless Chic ken Breas t    #__ ___ __ ___         Baked S c rod _#______ _ VENDO R S P A CE FE E:  $2 0.00          1 @  $ _ ______ ____ ________ T -S hirts :  Sm.  __ _ ____ M ed. _ _ ___ _ L g . __ _ _ _ _ X-Lg . _ _ _ _ XX - L g . _ _ _ ____ Sm., Med., Lg ., X- Lg ., $18. 0 0 eac h     X X- L g . $2 0. 0 0 e a ch          $ _ _ _ _ _ _ _ _ _ _ _ _ T otal Fal con R egist ration , T - shi rts & B anq uet A mo unt:               $ ____ ____ __ _ For H otel regist ratio ns call th e C row ne Plaza H o tel at 401-732-6000 Gro u p C ode F AL R oom rates are $ 129.00 plu s tax per nig h t gu ara n tee d u n ti l J u ly 20, 2021 Y ou must men tion F a lcon Clu b S h ow w h en maki n g y ou r reservati on s. Send this form a nd re mittance p ayable t o:  Nort heast Chap t er FC A , c/o Cristi ne Bow es, 55 2 Frankli n Roa d , Cove ntry , RI 0 2816 For more in formation , contac t Cristine B owes at (40 1) 529 -262 2 or f alcon sprint @ aol .com W AI V E R O F LIAB ILIT Y I ag re e not t o ho ld t h e No rth east Ch apt er , th e F alc o n Club of Ameri ca , o r t h e Crow n e P l az a Ho t el r es p o n sibl e for losses , damag es, o r inju r ies w h ile at this Co n v ent i o n . __ __ ___ __ _ __ __ _ __ _ __ _ _ __ __ _ __ _ _ _ __ __ _ __ _ __  _ _ __ __ _ ___ __ __ _ __ _ __ _ _ __ __ __ _ __ _ __ __ _ P r int N ame       S ign N am e