Centurion South Beach 2013 Registration Form

Centurion Account Executive: Choose One Grafing Mignone Singer Other

SELECT A SHOW: Choose One Centurion South Beach

RETAILER OR EXHIBITOR: Choose One Retailer Exhibitor Sponsor Guest

First Name Last Name

Company Name

Company Phone Mobile Phone

Company Address

City State Zip

Email Website

Attendee 1 First Name Last Name

Attendee 2 First Name Last Name

Attendee 3 First Name Last Name

Attendee 4 First Name Last Name

Attendee 5 First Name Last Name

List any Special Dietary Requests or Handicap Informtion for any of

 the above attendees:

Retailers--Please Fill In all Exhiibitors below with whom you anticipate writing an order at Centurion South Beach and from whom you would like to request a room at the Ritz Carlton. We will confirm requests with them on your behalf (a partial list of exhibitors is below for your convenience):

1884 Collection
Alishan
Artistry
Bizzotto Gioielli
Brumani
Charles Garnier
Dove’s Jewelry
Eli Jewels
Elizabeth Showers
ETHO
Frederic Sage
Fragments
Garavelli
Gem Platinum
Goshwara
Gumuchian
H. Weiss Company
H. J. Namdar
Hearts On Fire (suite)
Heather B. Moore
Henderson Collection
Honora
JB Star
Julius Klein
KC Designs
Lashbrook
Makur
Martin Flyer
Metalsmiths Sterling
Parlé
Ritani
Roberto Coin (suite)
S & R Designs
Suzanne Kalan
Uneek Jewelry
Vianna Brasil (suite)

If you do NOT need a room, which date(s) will you attend?
Choose One Sat., Oct. 5, 2013 Sun., Oct. 6, 2013 Mon., Oct. 7, 2013 Attending All Days

Please Complete the Section Below if you Need A Room/Rooms

Note: To complete the room section, in most cases you will need to left click your mouse in each box and type the needed information simultaneously. Sorry for the inconvenience.

Room 1 Arrival Date   Departure Date 

Room Type Room 1 Choose One King Bed Two Doubles

Room in Name of  

Room Shared With  

List any Special Room Requests 

Note: If you are a retail attendee, we will advise if exhibitor hosted room nights do not cover all of your planned room nights.

Credit Card Information (required)

Please choose below to advise how we will apply this credit card:

Choose One Use This CC Info for all of our rooms Use Individual CC Info for each Room

Card Type Choose One Amex MasterCard Visa Discover Card Number 

Exp Date (One or Two Digit Month/Two Digit Year) 

Security Code

(3 digits on back of MC or Visa, 4 on front of Amex) 

Billing Street Address  Billing Zip 


Room 2 Arrival Date  Departure Date 

Room Type Room 2 Choose One King Bed Two Doubles

Room in Name of  

Room Shared With  

List any Special Room Requests 

Note: If you are a retail attendee, we will advise if exhibitor hosted room nights do not cover all of your planned room nights.

Credit Card Information (required)

Please choose below to advise how we will apply this credit card:

Choose One Use Room 1 CC Info for this room Use Below CC Info for this Room

Card Type Choose One Amex MasterCard Visa Discover Card Number 

Exp Date (One or Two Digit Month/Two Digit Year) 

Security Code

(3 digits on back of MC or Visa, 4 on front of Amex) 

Billing Street Address  Billing Zip 


Room 3 Arrival Date  Departure Date 

Room Type Room 3 Choose One King Bed Two Doubles

Room in Name of  

Room Shared With  

List any Special Room Requests 

Note: If you are a retail attendee, we will advise if exhibitor hosted room nights do not cover all of your planned room nights.

Credit Card Information (required)

Please choose below to advise how we will apply this credit card:

Choose One Use Room 1 CC Info for this room Use Below CC Info for this Room

Card Type Choose One Amex MasterCard Visa Discover Card Number 

Exp Date (One or Two Digit Month/Two Digit Year) 

Security Code

(3 digits on back of MC or Visa, 4 on front of Amex) 

Billing Street Address  Billing Zip 

CANCELATION TERMS: If you reserve a room for the aforementioned show (provided through one or more exhibitors or billed directly to you) and you cancel your room(s) less than 30 days before the first day of the show or if you are a No-Show at the aforementioned show, you will be billed in full for all nights of your stay that have been reserved.

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