background image
PleaSe Print or tyPe
Organization:
Street Address:
City:
State/Province:
Postal Code:
Phone:
Name of Person Completing Form:
reGiStration FeeS (please check all that apply.)
early Bird rates (registration must be received by december 9, 2011)
NASMM Member - $549 per person
NASMM Member - second person: $449 per person
NASMM Member - Additional persons: $349 per person
NAPO/NSGCD Member - $579 per person
Guest Rate - $199 per person
Pre-Conference intensive Workshops
$129 - Session I - ___ Number or persons
$129 - Session 2 - ___ Number of persons
$199 - Sessions 1 & 2 - ____ Number of persons
regular rates
(registrations received december 10, 2011 - december 1, 2011)
NASMM Member - 1st person: $649
NASMM Member - second person: $549 per person
NASMM Member - Additional persons: $449 per person
NAPO/NSGCD Member - $679 per person
Guest Rate - $199 per person
non Member rates
Non Member - 1st person: $799
PayMent inForMation
Check Enclosed (Make Check Payable to NASMM)
Bill My:
VISA
MasterCard
Discover
Total:
Card Number:
Expiration Date:
Signature:
Credit Card Billing Address( if different than above)
Please indicate which complimentary food functions you will attend.
Pre-Conference
Session I
$129
Pre-Conference
Session II
$129
Pre-Conference
Sessions 1 & 2
$199
First Timers Time
YES
Breakfast
1/13
YES
Lunch
1/13
YES
Lunch
1/14
YES
Breakfast
1/15
YES
Assign me a Buddy!
yeS
i will be a Buddy!
yeS
Complete this form and mail to: NASMM Annual Conference, PO Box 209, Hinsdale, IL 60522. FAX to
630.230.3594. Payment must accompany this form. Make checks payable to NASMM. To receive the Early Bird
Deadline, register by December 9, 2011. Regular registration rates apply after that date. No registrations will
be accepted at the NASMM office after December 31, 2011. After December 31, 2011 you must register on site.
1. Name
E-Mail Address
REGISTRANTS: PLEASE PRINT CLEARLY - THIS IS HOW YOUR BADGE WILL READ. Please photocopy this form for additional registrants.
Registration Form
require vegetarian option at meals:
yeS
Please indicate which complimentary food functions you will attend.
2. Name
E-Mail Address
require vegetarian option at meals:
yeS
Please indicate which complimentary food functions you will attend.
3. Name
E-Mail Address
require vegetarian option at meals:
yeS
Pre-Conference
Session I
$129
Pre-Conference
Session II
$129
Pre-Conference
Sessions 1 & 2
$199
First Timers Time
YES
Breakfast
1/13
YES
Lunch
1/13
YES
Lunch
1/14
YES
Breakfast
1/15
YES
Assign me a Buddy!
yeS
i will be a Buddy!
yeS
Pre-Conference
Session I
$129
Pre-Conference
Session II
$129
Pre-Conference
Sessions 1 & 2
$199
First Timers Time
YES
Breakfast
1/13
YES
Lunch
1/13
YES
Lunch
1/14
YES
Breakfast
1/15
YES
Assign me a Buddy!
yeS
i will be a Buddy!
yeS
TOTAL REGISTRATION
FEES:
$