Download Form Company Name*Mailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Telephone*FaxEmail* Credit Card #*CVV*Expiration:Month*123456789101112Year*181920212223242526Please be sure to write name(s) as they should appear on name badge(s)Attendee Name* First Last Spouse/Guest First Last Home Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country MEETING REGISTRATION FEE $750.00 FOR EACH PERSON / COUPLE ATTENDING IF RECEIVED BY FEB. 7, 2020 FEE IS $850.00 IF RECEIVED AFTER FEB. 7, 2020 ONE-TIME NON-MEMBER FEE IS $1100.00 ALL REGISTRATION FORMS AND FEES MUST BE RECEIVED ON/BEFORE: FEBRUARY 14, 2020 REGISTRATION FEE IS NON-REFUNDABLE AFTER FEBRUARY 14, 2020 Registration fee may be paid by check or credit card, make checks payable to: Automotive Safety Council Please mail or fax completed forms to: AUTOMOTIVE SAFETY COUNCIL 5572 Arbor Bay Ct Brighton MI 48116 Fax: (810)225-8567 IMPORTANT NOTICE: ALL ACCOMMODATIONS AT Margaritaville Beach RESORT MUST BE RESERVED THROUGH THE ASC. If you do not plan to stay at the resort and do not want the ASC to reserve accommodations for you SKIP to the EVENT/SOCIAL RESERVATIONS section and complete the remainder of the form. Hotel ReservationsAll rooms are Deluxe run-of-house rooms with 1 king or 2 queen beds. NOTE: Upgraded rooms or suites MAY be available upon request at higher nightly rates. Contact ASC to requestArrival Date Date Format: MM slash DD slash YYYY Departure Date Date Format: MM slash DD slash YYYY Credit Card NumberCVVExpirationMonth123456789101112Year17181920212223242526 Room rate at Margaritaville Beach Resort is $335.00 + 12.0% tax, single or double occupancy; daily resort fee is $25. A one-night deposit incl. tax will be charged to your credit card to reserve and guarantee your room. THIS SPECIAL GROUP RATE IS AVAILABLE ONLY IF YOUR RESERVATION IS THROUGH THE ASC AND RECEIVED PRIOR TO FEBRUARY 14, 2019 Event / Social ReservationsASC Annual Golf Tournament ASC ANNUAL GOLF TOURNAMENT Friday, March 20th at 1:15 p.m. Please provide complete information for all players Player's Name First Last HandicapNeed Rental Clubs?Right HandLeft HandNoPlayer's Name First Last HandicapNeed Rental Clubs?Right HandLeft HandNoTHE ASC GOLF TOURNAMENT IS OPEN TO ALL MEMBERS, SPOUSES AND GUESTS. GREENS FEES: $99 + tax p.p., CLUB RENTAL: $75 + taxASC Complimentary Spouse/Guest Excursion ASC COMPLIMENTARY SPOUSE/GUEST EXCURSION A river cruise down the 'Venice of America' on the jungle Queen Boat with lunch afterward at GG's Waterfront Restaurant Thursday, March 19st - 9:30 a.m. Participant's Name First Last Cellphone ContactTotal Number of ParticipantsOptional Ocean Fishing ExcursionOPTIONAL OCEAN FISHING EXCURSION:Friday, March 20th - 1:00 P.M. - 5:00 P.M.$180/person + taxOcean Fishing ExcursionOcean FishingParticipant's Name First Last Total Number of ParticipantsASC Social EventsWelcome Reception, Wednesday, March 18 - 6:00-8:00 p.m.*Select OneYes, I/we will attendNo, I/we will not attendBusiness / Resort CasualHosted Reception, Thursday, March 19 - 6:00-7:30 p.m.*Select OneYes, I/we will attendNo, I/we will not attendResort CasualFarewell Reception, Dinner & Dancing Saturday, March 21 - 6:00-11:00 p.m.*Select OneYes, I/we will attendNo, I/we will not attendResort DressyCommentsThis field is for validation purposes and should be left unchanged.
Download Form