National Culinary Review

2010 ACF REGIONAL CONFERENCE REGISTRATION

REGISTRATION FORM (Please complete one form for each person attending.) Spouse pays the same rate as member.  Check here if you are a member’s spouse.

Name ________________________________________________________ Membership ___________________________ Chapter ID ________________________

Home address _________________________________________________ City ____________________________ State ________________ Zip _________________

Home e-mail* __________________________________________________ Home phone _____________________________ Cell phone _________________________

Employer ______________________________________________________ Position title ________________________________________________________________

Work address __________________________________________________ City ____________________________ State ________________ Zip _________________

Work e-mail* ___________________________________________________ Work phone ______________________________ Fax _______________________________

*If provided, you may receive e-mail notices of products and special offers from sponsors and exhibitors. Your registration confirmation will be sent by e-mail.

Please answer the following questions so that we may better serve you. Check one:

Badges and tickets must be picked up on-site at the preregistration desk. For special services, call ACF Events Management (800) 624–9458 or e-mail events@acfchefs.net

Select from the following conferences:

 West (February 6-8)  Northeast (March 13-15)  Central (March 26-28)  Southeast (April 24-26)

FULL REGISTRATION PACKAGE includes conference meal functions and badge for entrance to educational programming and trade show. Early registration deadlines apply for each event. Please visit www.acfchefs.org for specific dates and registration deadlines unique to each conference.

Member Status Early Regular and on-site

Culinarian/Professional Culinarian  $375  $475 Junior/Senior/Student  $325  $425 Allied/Associate  $375  $475 Culinary Enthusiast  $375  $475 Non-ACF Member  $475  $575

A LA CARTE REGISTRATION OPTIONS

Badges (includes breakfast)

 One-Day Conference Program Badge

 Day 1  Day 2  Day 3 ___________ x $95 = __________

Meal Tickets

 Breakfast  Day 1  Day 2  Day 3  Ice Breaker Reception

 Trade Show Lunch

 Chef Professionalism Lunch

 Conference Lunch

 Awards Gala—Celebrating Regional Excellence  Meal Package

Includes Trade Show Lunch, Chef Professionalism

Lunch, and Awards Gala

 American Academy of Chefs Dinner ___________ x $125 = __________

Kids ( 12 years or younger)

 Awards Gala ___________ x $50 = __________

Education

Educator Development

Morning Session

Afternoon Session

Career Development—Nutrition Track

Includes Mandatory Test

___________ x $25 = __________

___________ x $50 = __________

___________ x $45 = __________

___________ x $125 = __________

___________ x $200 = __________

___________ x $75 = __________

Total Due For Registration $________________

Refund Policy: Request for refund must be made in writing and postmarked no later than 30 days prior to start of event. A $50 processing fee will be deducted from refund amount.

Payment Made By:

 Check  Money Order (Make payable to: American Culinary Federation)

Credit Card (select one)  VISA  MasterCard  American Express  Discover

Credit Card ____________________________________ Expiration Date ______ / ____________ Name on Card ______________________________________________________________________ Signature ________________________________________________ Date ______ / ____________ My signature hereby authorizes ACF and its subsidiaries, vendors and the media to use the reproduction ( photographic or video) of my likeness, work product(s), recipes and/or presentations for distribution in both print and digital matter. I understand ACF has the right to make copies of such materials to make available for sale and to retain the proceeds from the sale of such, and that I will not be compensated and may not be notified of use. Signature ________________________________________________ Date ______ / ____________

Gender:
 Male  Female
Type of Establishment:
 Air/Cruise/Rail
 Bakery
 Bed & Breakfast
 Catering
 Conference Center
 Consulting
 Correctional Institution
 Country Club
 Distributor
 Executive Dining
 Fast Food/Supermarket
 Govt. Facility/Armed Forces
 Hospital/Healthcare
 Hotel/Inn
 Manufacturer Corporate HQ
 Multi-unit Corporate HQ
 Personal Chef/Private Chef
 Residential Community
 Resort
 Restaurant, Independent
 Restaurant, Multi-unit
 Sales/Marketing
 School-Other
 School-Postsecondary/Private
 School-Postsecondary/Public
 School-Secondary/Private
 School-Secondary/Public
 Theme/Sports Park
 Other
Restaurant Type:
 Fine Dining
 Casual Dining
Annual Revenue/
Sales Volume:
 Under $200K
 $200K - $299K
 $300K - $499K
 $500K - $1 million
 $1 -$5 million
 Over $5 million
 Don’t Know
Annual Food
Purchase Volume:
 Under $50,000
 $50K - $150K
 $150K - $300K
 $300K - $1.5 million
 Over $1.5 million
 Don’t Know
Your Purchasing Role:
 Directly Responsible
 Influence Decisions
 None

Current Position:  Apprentice  Baker  Banquet Manager  Bar Manager  Broker/Sales Representative  Catering Director  Consultant  Cook  Dietitian  Educator  Executive Chef  Food/Beverage Manager  General Manager  Inspector  Kitchen Manager  Owner  Pastry Chef  Personal Chef  Private Chef  Research Chef  Restaurant Manager  Retired  Sous Chef  Student  Unemployed  Wine Steward/Sommelier I Perform This Role for the Following Products (check all that apply):  Beverage  Equipment  Food  Tabletop  Apparel  None Highest Education Completed:  High School/GED  Culinary Certificate Program  Associate’s Degree  Bachelor’s Degree  Master’s Degree  Doctorate  Other Your Culinary Training:  Apprenticeship Program  Certificate Program  High School Culinary Program  Military  On the Job  Other College or University  Private Culinary College  Public Culinary College  None  Other

Mail or Fax to: American Culinary Federation • 180 Center Place Way • St. Augustine, FL 32095 Fax 904-825-4758 • Phone: 800-624-9458 Register online at www.acfchefs.org