La Fleur’s 2011 Lottery Conclave Registration Form

(Renaissance Chicago Downtown Hotel, Chicago, Illinois—September 11-14, 2011)

Registration fees cover the four-day conference, opening night cocktail reception, continental breakfasts, coffee breaks
and two luncheons. Each delegate must fill out a separate form. Please send form with the payment (credit card or cash
payment) to register. Make checks payable in U.S. funds to: TLF Publications, Inc. Mail registration to: TLF Publications,
51 Monroe Street, Suite 1502, Rockville, MD 20850 U.S.A. Fax registration to: (301) 610-6072. Questions: (301) 610-6070.
Register Online at www.lafleurs.com
First Name Last Name

Job Title

Government Agency or Company

Mailing Address

City State/Province/Country
Zip/Postal Code

Business Phone (include area code) Cell Phone (include area code)

E-Mail Address Business Fax (include area code)

Government Personnel Registration Fees §

RESTRICTED RESTRICTED RESTRICTED

Earlybird Registration Regular Registration Premium Registration
(by 7/18/11) (by 8/18/11) (after 8/18/11)
One Government Organization Personnel Registration $550 $600 $650
Five Government Registrations (Buy 4, Get 1 Free) $2,200 $2,400 $2,600

Corporate Vendor / Supplier/ Ad Agency Registration §

RESTRICTED RESTRICTED RESTRICTED CANCEL ANYTIME

Earlybird Registration Regular Registration Premium Registration Registration
(by 7/18/11) (by 7/18/11) (after 8/18/11)
One Corporate Registration $1,100 $1,150 $1,200 $1,350
Spouse $295 $295 $295
TOTAL AMOUNT OF MONEY PAID BY CHECK OR CREDIT CARD: $________
§ Please Note: RESTRICTED registration fees are non-refundable after July 18, 2011. There are no exceptions to this rule.
Delegate substitutions are acceptable. Registration fees are not exchangable for future La Fleur’s conferences. The CAN-
CEL ANYTIME registration fee allows a vendor to cancel his/her registration at any time and receive a full monetary
refund. To charge your registration fee, please check the credit card type and complete the card number and expiration
numbers below:
Charge to: o American Express o Mastercard o Visa
Credit card number Credit Card Expiration Date

Reserving A Room At The Renaissance Chicago Downtown Hotel

Delegates are responsible for registering for their own room at the Renaissance Chicago Downtown Hotel in Chicago, Il-
linois. The symposium organizer, La Fleur’s Magazine, does not book rooms for delegates. Delegates can register online at:
http://www.marriott.com/hotels/travel/chisr?groupCode=laflafa&app=resvlink&fromDate=9/11/11&toDate=9/14/11
link. Delegates can also call the Renaissance Chicago Downtown Hotel’s reservations department at 1-800-468-3571 to book
a room (ask for La Fleur’s 2011 Lottery Conclave room rate). La Fleur’s Magazine has reserved a limited block of rooms at a
discounted rate of $252 per day (exclusive of applicable city and state taxes) for the three nights of the conclave. The rack
rate is $450 during this period. After the room block is depleted, the hotel will charge its regular rack rates. The hotel’s ad-
dress is: Renaissance Chicago Downtown Hotel, 1 West Wacker Drive, Chicago, ILL 60601. All rooms must be guaranteed
with a credit card.