Download Form ASC 2023 Annual General Meeting Registration Form March 22 - March 26 – Hyatt Regency Grand Cypress Resort and Spa – Orlando, FL "*" indicates required fields 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 FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Telephone*FaxEmail* Credit Card #* CVV* Expiration:Month*123456789101112Year*2223242526Please 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 FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country MEETING REGISTRATION FEE $850.00 FOR EACH PERSON / COUPLE ATTENDING IF RECEIVED BY FEB. 17, 2023 FEE IS $950.00 IF RECEIVED AFTER FEB. 18, 2023 ONE-TIME NON-MEMBER FEE IS $1200.00 ALL REGISTRATION FORMS AND FEES MUST BE RECEIVED ON/BEFORE: FEBRUARY 27, 2023 NON-REFUNDABLE Registration fee may be paid by check or credit card, make checks payable to: Automotive Safety Council IMPORTANT NOTICE: ALL ACCOMMODATIONS AT HYATT REGENCY GRAND CYPRESS RESORT AND SPA MUST BE RESERVED THROUGH THE ASC. If you do not plan to stay at the 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 Reservations All 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. Use the following URL to reserve your room: https://www.hyatt.com/en-US/group-booking/VISTA/G-ASC3 Block rates are good for 3 days before and after the conference pending availability. If you want any nights outside March 21-25 or any other special requests, please contact Lee Ballas at [email protected] Room rate at Hyatt Regency Grand Cypress Resort and Spa is $239.00 + tax + $10 resort fee, single or double occupancy only. Upgraded rooms may be available at a higher cost. A one-night deposit incl. tax will be charged to your credit card to reserve and guarantee your room. For anyone driving a car, there is an overnight daily parking fee of $15. THIS SPECIAL GROUP RATE IS AVAILABLE ONLY IF YOUR RESERVATION IS THROUGH THE ASC AND RECEIVED PRIOR TO FEBRUARY 27th, 2023 Cardholder Signature*ASC Annual Golf Tournament ASC ANNUAL GOLF TOURNAMENTGrand Cypress Golf Club Friday, March 24th at 1:15PM Shot Gun Start Please provide complete information for all players ParticipantsPlayer's NameHandicapNeed Rental Clubs? Left HandRight HandNone Add RemoveParticipantsPlayer's NameHandicapNeed Rental Clubs? Add RemoveTHE ASC GOLF TOURNAMENT IS OPEN TO ALL MEMBERS, SPOUSES AND GUESTS. GREENS FEES: $184 p.p., CLUB RENTAL: $45 + taxASC COMPLIMENTARY SPOUSE/GUEST EXCURSIONFlorida Everglades Air Boat Tour and Lunch Thursday, March 23rd - 9:00AMParticipant's Name(s) Cellphone ContactTotal Number of ParticipantsOptional Charter Boat Bass Fishing ExcursionOPTIONAL CHARTER BOAT BASS FISHING EXCURSION Friday, March 24th - 1:00 - 6:00 p.m (Cost TBD)Participant's Name(s) Total Number of ParticipantsASC SOCIAL EVENTSWelcome Reception, Wednesday, March 22 — 6:00 - 8:00PM*Select OneYes, I/we will attendNo, I/we will not attendBusiness / Resort CasualHosted Reception, Thursday, March 23 — 6:00 - 7:30PM*Select OneYes, I/we will attendNo, I/we will not attendResort CasualFarwell Reception Dinner & Dancing, Saturday, March 25 — 6:00 - 11:00PM*Select OneYes, I/we will attendNo, I/we will not attendResort DressyCommentsThis field is for validation purposes and should be left unchanged.
