New Year’s Day Parade London  2009
Convention Registration Form




There are no multiple registrations available. Please complete this form in its entirety for each individual being registered.

Fields marked by an asterisk (*) are required.

Please enter your chapter information
*Roommate:
*Your passport number:
*Your passport expiration date:
*Emergency contact name:
*Emergency contact phone number:
Personal Information
Purple Perks ID:  - 
*First Name:
*Last Name:
*Street Address:
Unit Number (if applicable):
*City:
*State/Province:
*ZIP or Postal Code:
*Country:
Please enter your Email Address
for speedier confirmation and event updates.
*Phone:
Convention Options
*Program Package
Choose a Departure Gateway City or Land package only 
1. Depart from Washington Dulles    $2,823.00
1a. Deposit for departure from Washington Dulles    $300.00
2. Depart from Atlanta, GA    $2,865.00
2a. Deposit for departure from Atlanta, GA    $300.00
3. Depart from Chicago, IL    $2,876.00
3a. Deposit for departure from Chicago, IL    $300.00
4. Depart from Los Angeles, CA    $2,968.00
4a. Deposit for departure from Los Angeles, CA    $300.00
5. Depart from San Francisco    $2,968.00
5a. Deposit for departure from San Francisco    $300.00
6. Land Only    $1,938.00
6a. Deposit for Land Only    $300.00
Are you a Red Hatter or a Pink Hatter?
We want to know who you are! Please tell us if you are a pink hatter or a red hatter. 
I am a Pink Hatter.
I am a Red Hatter.
Not applicable
*Single Occupancy Supplement
I prefer to have a room by myself for an additional $475 
1. Yes    $475.00
2. No, thanks
*ADA Accomodations
Do you have special ADA accommodations for the convention (i.e. wheelchair access, listening devices, etc.)? We will contact you for more details. 
1. No, I do not have special ADA needs.
2. Yes, please contact me for more information.
Tour Choice for Tuesday, December 30, 2008
Please select the tour that you would like to participate in 
Hampton Court
Windsor
Hotel Accommodations
Please indicate your hotel preference: 
1. Single Bedded Room
2. Double Bedded Room
3. Triple Bedded Room
Tour Choice for Friday, January 2, 2009
Please select the tour that you'd like to participate in 
Bath and Stonehenge
Oxford University and Stratford Upon Avon
Travel Insurance
Do you wish to purchase Travel Insurance for an additional $50 per person? If you have enjoyed your 71st birthday, the cost of insurance is $90 
No thanks
Yes, I am 71 or wiser and want Travel Insurance for $90
Yes, I am under the age of 71 and want Travel Insurance for $50