Va Form 0926k - Non-Athlete Meals
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1ATHLETE NUMBER-OFFICE USE ONLY
OMB Number:
Respondent Burden: 20 minutes
NON-ATHLETE MEALS
RESPONDENT BURDEN: The Paperwork Reduction Act of 1995 requires us to notify you that this information collection is in accordance with the
clearance requirements of Section 3507 of the Paperwork Reduction Act of 1995. We may not conduct or sponsor, and you are not required to respond to,
a collection of information unless it displays a valid OMB number. We anticipate that the time expended by all individuals who must complete this
application will average 20 minutes. This includes the time it will take to read instructions, gather the necessary facts and fill out the forms.
Meals are furnished for all Athletes (no charge). Coaches, support staff, family members, and others may purchase meal tickets at the costs
listed below. The only meals sold separately are the meals at the special events listed below. If you select "Lunch and Dinner" - the two
special events are already included in that price.
Please note that there are a limited number of restaurants within walking distance of the hotel.
NON-ATHLETE NAME (Please print)
CHOOSE THE FOLLOWING
BREAKFAST ONLY (5/31 - 6/5 at the host hotel)
$90
LUNCH AND DINNER ONLY* (5/31 - 6/5 at the America's Center)
$276
*Special event meals included in this price.
ALL MEALS (Breakfast, lunch and dinner 5/31 - 6/5)
$366
NO MEALS
SPECIAL EVENTS MEALS ONLY (No meals will be served at the America Center during these two special events)
You may choose one or both
6/1 FRIDAY EVENING
GATEWAY GRIZZLIES BUFFET AND GAME
$18
6/4 MONDAY EVENING
CASINO QUEEN CASINO MEAL/SPECIAL EVENT
PAY ON YOUR OWN AT THE CASINO
All guests at the casino must be 21
$
TOTAL DUE:
METHOD OF PAYMENT
CHECK (Please make checks payable to St. Louis VAMC GPF 8199)
MONEY ORDER
CREDIT/DEBIT CARD
CREDIT/DEBIT CARD NUMBER:
EXPIRATION DATE
CARDHOLDER NAME:
CREDIT CARD BILLING ADDRESS
SIGNATURE
Please Note:
Everyone is required to pay in advance; we will not cash your check or charge your account until after your arrival at registration.
Cancellations will be honored by having your check returned after the conclusion of the games in June.
There will be no opportunity for non-Athletes to purchase meal tickets on site. No meals will be provided to non-Athletes without
meal tickets. Individual meals will not be sold other than for the Night at the Ballpark and Casino Night.
Please note that all breakfast meals will be provided at the host hotel and all lunch/dinner meals other than special events will be provided
at America's Center. Boxed lunches will be provided for off-site events, when unable to eat at the America's Center.
PLEASE RETURN THIS FORM AND PAYMENT WITH YOUR REGISTRATION PACKAGE BY FEBRUARY 29,
2012.
WE WILL NOT CASH CHECK OR CHARGE ACCOUNTS UNTIL AFTER REGISTRATION ON MAY 31, 2012.
CHECKS MADE PAYABLE TO: ST. LOUIS VAMC GPF 8199
0926k
VA FORM
OCT 2011
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