All registration forms must be received by September 17, 1999.

Note: Fields marked with a red asterick must be completed.
* First Name:
* Last Name:
* Badge Name:
* Company:
* Title:
* I am a: Circle of Success Member UniDial Direct Rep UniDial Employee UniDial Vendor
* Agent/Direct ID No.:
Guest First Name:
Guest Last Name:
Guest Badge:
* Business Address 1:
(no post office boxes, please)
Business Address 2:
* City:
* State:
* Postal Code:
* Business Tele:
Business Fax:
Home Phone:
Email address:

UniDial Travel Headquarters will confirm your room reservations at the Westin La Cantera Resort for arrival on October 20 and departure on October 23, 1999 unless otherwise noted below. If you plan to arrive before or depart after these dates, please make arrangements with UniDial Travel Headquarters. All hotel reservations made outside of the program dates will be at your own expense.

Please note: Circle of Success members, President's Club members, and special guests will be charged full room and tax at the Westin La Cantera Resort at a room rate of $135.00 per night for single or double occupancy. All other rooms reserved at the hotel will be charged at the regular room rate of $234.85. To receive the special room rate you must make reservations before September 17, 1999. Please click here unidial@tpgnc.com to submit your credit card information to UniDial Travel Headquarters, otherwise we will have a Travel Headquarters agent contact you directly.
* Check In: (mm/dd/yy)
* Check Out: (mm/dd/yy)
* Smoking/Non-Smoking: Non-Smoking Smoking
Bed Type:
Special Needs/Request:

UniDial will be hosting a golf tournament and river rafting for guests to enjoy on Thursday, October 21, 1999.
* Activity: Golf Tournament Rafting Afternoon on my own
Guest Activity: Golf Tournament Rafting Afternoon on their own
Yes, I am golfing. I will need: Right-handed clubs Left-handed clubs I do not need clubs
Yes, my guest is golfing and will need: Right-handed clubs Left-handed clubs My guest does not need clubs
My handicap is:
* Shirt Size: [S] Small [M] Medium [L] Large [XL] X-Large [XXL] XX-Large
Guest Shirt Size: [S] Small [M] Medium [L] Large [XL] X-Large [XXL] XX-Large

If you are a UniDial employee you must contact Bernice at (502) 394-0789 ext. 1711 to make your air reservations. If you have already made your air travel arrangements please fill in the specifics below. If you are not a UniDial employee and you need assistance with your air travel arrangements, please call UniDial Travel Headquarters at (800) 942-6020.
Arrival Date: mm/dd/yy
Flying From:
Flt No.:
Arrival Time: AM PM
Departure Date: mm/dd/yy
Flying To:
Flt No.:
Departure Time: AM PM