Please include full name, address, phone number and email address for each person registering. If there are others in your party, please indicate so we may seat you together at the TBAI Feast.

Print this page and complete the following information (please print clearly):

Name: __________________________________________________________

Address: ________________________________________________________

City: ___________________________________________________________

State: ___________ Zip Code:____________ Country: ____________________

Telephone #: _____________________ Email: ______________________

____	I/we won't miss the wonderful Thursday evening Gala! Count on me/us to share this very special memorable evening with friends from around the world. Free will donation at event.

Complete TBAI 2011 Convention Activity Package..........................$185.00

Check your choice for Friday morning activity:

____	Visit to The Bundy Arts & Victorian Museum, Binghamton, NY
____	Penny French presentation "How to Create Seasonal displays" followed by "Charades"!!

Check if you wish to attend Friday afternoon activity:

____	"The Pirate In Me" Bring a wrapped bear related gift and have fun stealing from your fellow friends.

Check your choice for the TBAI Feast: (if reg. more than one person and different meals place name on line next to menu choice)

____	Filet Mignon - 8 oz. choicest tenderloin (medium)
____	Chicken Duxelle - Boneless Chicken Breast Stuffed w/Mixture of Finely Chopped Mushrooms & Herbs
____	Sambucca Swordfish - Grilled Swordfish w/sauteed Sun Dried Tomatoes, Shallots and Mushrooms finished w/a light Cajun Red Sauce with a hint of Sambucca
____	Stuffed Eggplant (Meatless) - Eggplant Stuffed with Italian Seasonings and Cheeses

If you can only join us for part of the activities, please indicate below:

____	Friday morning activities: Continental breakfast, Friday activity (check choice above), and Sabro Square Deli Lunch	$65.00
____	Friday evening activities (please make your feast selection above)	$75.00
____	Saturday Buffet Breakfast/TOBY Public's Choice Awards	$25.00
____	Saturday evening Cookout at the Zoo	$30.00

Enclosed is a check in the amount of __________ made payable to TBAI.

Charge my Visa or MasterCard (circle one):

Credit Card # _____________________________________ Exp Date: _________ CW2: ________(3-digit # on back of card)

 Name as it appears on the card: ________________________________________

Signature of Cardholder ______________________________ Date: ___________

NOTE: All prices are represented in U.S. Currency. To ensure proper exchange rate, please use a credit card outside of the United States.

Mail to:	TBAI
	4131 State Rte 9
	Plattsburgh NY 12901
	USA

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