Please Come Join Us At The Fabulous Las Vegas Motorcoach Resort For POG XI

October 1 to October 5, 2012

Last Name_________________________________________First Name_________________________&______________________

Address____________________________________________City_____________________________St__________Zip____________

Email_______________________________________________POG Handle_______________________________________________

Shirt Sizes________________________&______________________

Amount Due

Rally Fee ( 2 people ) $ 599 per Coach _______________________

Rally Fee       no coach                    $ 175 per Person _______________________

 Cirque Du Soleil Dinner Show $ 90 per person _______________________ Must Have Reservation by 7-15-2012

Additional Guests $ 150 per person _______________________

                                                                            Total Due _______________________

Credit Card Info: Card#____________________________________________________Exp_________________CCV______________

Please send Registration Sheet  to :

Email: Prevostlife@gmail.com

 Fax : 888-651-5307

Please Call If You Have Any Questions : 352-552-4812

Cancellation Policy : Cancel by 9/1/12 - 100% refund – cancel between 9/1 and 9/15/12 - 50 % refund – cancel after 9/15/12 - sorry – no refund.