Advance Registration Form NSTA Area Conference
(See Registration Instructions on reverse.) Baltimore, Maryland
You can also register online at www.nsta.org/conferences November 2–4, 2006
❐ I have already registered for the BALTIMORE conference and wish to add tickets. ❐ This is my initial registration for BALTIMORE.
❐ I am a member of NSTA. Member ID # ___________________________________
❐ I am not a member of NSTA but wish to join. I have included my membership application* and dues with my registration payment.
❐ I am not a member of NSTA.
Personal Information Please print or type. Information with * will appear on your badge. ❐ Check for no e-mail from exhibitors.
First Name* ____________________________________ MI* __________ Last Name* __________________________________________________
Job Position/Title* ________________________________________________________________________________________________________________
Name of Institution/Affiliation* ______________________________________________________________________________________________________
Work Mailing Address _____________________________________________________________________________________________________________
City* _______________________________________ State/Province* _____________ Country _____________________ Zip ________________
Home Mailing Address _____________________________________________________________________________________________________________
City ________________________________________ State/Province ______________ Country _____________________ Zip ________________
I prefer to receive mail at: ❐ Home ❐ Work
Daytime phone _________________________ Fax _____________________________ E-MAIL ______________________________________________
Name of spouse/guest attending conference with you ______________________________________________________________________________________
Name(s) of children attending conference with you (high school age and under register for free) _______________________________________________________
❐ Check here if you need SPECIAL ASSISTANCE due to a disability. Describe on extra sheet and attach, including evening phone number if applicable.
Disciplines (check all that apply) Position (check all that apply) Grades (check all that apply) Institution (check all that apply)
❐ Earth Science ❐ Computer Sci. ❐ Teacher ❐ Student ❐ PreK–K ❐ 8th Grade ❐ Public School ❐ 2-year College
❐ Biology ❐ Tech. Education ❐ Professor ❐ Scientist ❐ 1st Grade ❐ 9th Grade ❐ Private School ❐ 4-year College
❐ Chemistry ❐ Dept. Head/Chair ❐ Consultant ❐ 2nd Grade ❐ 10th Grade ❐ Laboratory ❐ Graduate School
❐ Physics ❐ Principal ❐ 3rd Grade ❐ 11th Grade ❐ Business ❐ Retired
❐ Environmental Science ❐ Supervisor/Coordinator ❐ 4th Grade ❐ 12th Grade ❐ Informal Education
❐ Physical Science ❐ Administrator ❐ 5th Grade ❐ College ❐ Home School
❐ General Science ❐ Professional Develop. Provider ❐ 6th Grade ❐ Library
❐ Other ____________________ ❐ Other ____________________ ❐ 7th Grade ❐ Other____________________
Registration Fees Ticket Orders See reverse for details. Payment
Please circle correct amount. Earlybird Advance Full Rate
Registration Fee $ ________
9/22/06 10/6/06 After 10/6 Short Courses/Symposia/ELL Confer-
Two to Three Days ence Spouse/Guest Fee $ ________
Event # Qty. X Price = Total Membership Fee (form attached) $ ________
❐ Current NSTA member or applicant $120 $130 $155
______ ____ ______ ______
❐ MAST member #_____________ $120 $130 $155 Tickets (from Ticket Orders) $ ________
______ ____ ______ ______
❐ Nonmember $194 $204 $229 ______ ____ ______ ______ Total Due: $ ________
❐ Retired NSTA member #__________ $65 $75 $95
I am paying by:
❐ International (except Canada) $65 $75 $95 Social Functions
Social # Qty. X Price = Total ❐ Check #_____ (payable to ‘National Science
❐ Full-time student $55 $65 $85
______ ____ ______ ______ Teachers Association’ in U.S. funds)
One Day Only–Check Day: ❐ Thu ❐ Fri ______ ____ ______ ______
❐ Nonstudent (member or nonmember) $105 ______ ____ ______ ______ ❐ Credit Card:
❐ AMEX ❐ Discover ❐ MasterCard ❐ VISA
❐ Full-time Student $25 $30 $45
Field Trips # _______________________________
Last Day Only–Saturday Trip # Qty. X Price = Total
❐ Nonstudent (member or nonmember) ______ ____ ______ ______
$75 $80 $90 Signature:_________________________
______ ____ ______ ______
❐ Full-time Student $25 $25 $45
______ ____ ______ ______
❐ School Purchase Order (copy attached):
❐ Nonteaching Spouse/Guest $45 $55 $70 PO No. ___________________________
(enter name above) Subtotal ______
Mail or fax your completed form with payment to: National Science Teachers Association, Conferences Department, PO Box 90214,
Washington, DC 20090-0214, FAX: 703-243-3924, or register online at www.nsta.org/conferences.
Registration Instructions You must register by the advance deadline to receive your badge, tickets,
and confirmation in advance of the conference. If you mailed or faxed your
This form is for the use of conference participants only. Individuals register-
registration before the advance deadline and if by October 17 you have
ing to conduct business must contact the Exhibits Department to register as
not received your confirmation packet, call NSTA conference registration at
a Non-exhibiting Industry Representative.
703-243-7100 or 800-328-8998 or e-mail firstname.lastname@example.org.
Each registrant (except nonteaching spouse) must submit a separate
If your registration is postmarked after the advance deadline you will be
registration form. Do not send duplicate registrations—if you fax your
charged at the full on-site rate and your confirmation may not be mailed to
form, do not also mail the form.
you before the conference. Pick up your confirmation, badges, and tickets
Registration fees cover all nonticketed conference activities and entry to the on-site at the Problem Solving Counter in the NSTA Registration Area.
Exhibit Hall. Fees do not cover ticketed events, meals, lodging, or transporta-
tion other than NSTA-contracted shuttle service. Ticketed Events
Information on ticketed events can be found in this program and on NSTA’s
Registration Rates website (www.nsta.org/conferences). Tickets are available on a first-come/first-
The member rate: served basis. If you are registered for the full meeting (two–three days), you
Only those individuals listed below may register at the NSTA member rate: may purchase tickets for any available event. If you are registering for one day
only, you may buy tickets only for those events that take place on the day for
• Current NSTA members which you are registering.
• Nonmembers who submit an NSTA membership application along with There are two prices for ticketed events: the advance price and the on-site
the registration form price. To qualify for the advance price, your registration with ticket purchases
must be postmarked or faxed by the advance registration deadline of October
• Members of the Maryland Association of Science Teachers (MAST)
6. Tickets are nonrefundable.
The retired member rate: If you have already registered for the Baltimore conference, you may use this
NSTA members who are fully retired and have been an NSTA member for at form to add tickets. Check the box "I have already registered for the BALTIMORE
least five years may register at the retired rate. conference..." at the top of the Registration Form and list the tickets you wish
The international rate: to purchase under “Ticket Orders.” Be sure to provide your name and address
Attendees from countries other than the U.S., U.S. territories, and Canada and your NSTA member number if applicable.
may register at the international rate. You cannot add tickets to a previous registration online (even if you originally
The student rate: registered online). You must submit a new form.
Full-time students 18 years of age or older may register at the student rate
if the registration form is accompanied by a copy of a current university ID Submitting Your Registration
or a letter from the university indicating fulltime enrollment. Payment for registration and membership (if attaching membership
application) must be included with your registration form. Forms received
Registration to attend a National Science Teachers Association (NSTA) without payment will be returned unprocessed. Payment may be made by
conference means permission is granted to NSTA to use attendee’s photo in credit card, check, or purchase order from your school or school district (attach
NSTA marketing and promotional pieces about the Association for an forms for all registrants). Mail or fax your completed form with payment to:
indefinite period of time. Promotional pieces include, but are not limited to,
printed brochures, reports, postcards, and flyers, as well as online uses such National Science Teachers Association
as postings on the NSTA website and e-mail blasts. Conferences Department
PO Box 90214
Spouse/Guest/Children Attending Conference Washington, DC 20090-0214
Your nonteaching spouse/guest and children must be registered in order to
visit the Exhibit Hall but do not need to submit separate registration forms.
Please provide their names on your own registration form. Children of high Refund requests must be in writing and must be postmarked 10 days before
school age and under can be registered for free. A fee is required for your the conference. Badge materials must be returned with refund request.
spouse/guest. College students and teaching spouses must submit separate Registration cancellations are subject to a $20 processing fee. Ticketed
registration forms and payment. events are nonrefundable.
Contact NSTA conference registration at 703-243-7100 or 800-328-8998,
Registrations postmarked (or faxed) by the earlybird deadline of Septem-
or via e-mail at email@example.com. For general information on the Baltimore
ber 22 or the advance deadline of October 6 have substantially lower fees
conference or to register online, visit our website at www.nsta.org/
than full on-site registration.
Become an NSTA member and save when you register for 2–3 days!
Simply complete a membership application and include it and your payment with your registration form.
Maximize Your Potential in the Classroom—
Join NSTA Today and Save!
Gain year-round access to the latest news and information affecting science education.
1. Membership Options Each membership op-
tion listed below includes one journal.
2. Contact Information (please print)
❏ Individual Membership—$74/yr. Name ______________________________________________________________
❏ New Teacher—$32/yr. Teachers who are in their ﬁrst Title _______________________________________________________________
three years of teaching. Send a copy of your teaching Institution __________________________________________________________
certiﬁcate or a letter from your administrator.
❏ Home ❏ Work
❏ Retired—$32/yr. Science educators who are fully re-
tired and have been an NSTA member for at least ﬁve Address ____________________________________________________________
years. Address ____________________________________________________________
❏ Student—$32/yr. For full-time students only. Include City ______________________________ State _______ Zip ________________
proof of current registration with your payment.
Instructor must sign here: Country ____________________________________________________________
Work Phone ________________________________________________________
_______________________________________________ Home Phone _______________________________________________________
❏ Joint NSTA/NATS—$89/yr. Includes membership in Fax ________________________________________________________________
both Nebraska Association of Teachers of Science and
❏ Joint NSTA/MAST—$74/yr. Includes membership in Have you ever been an NSTA member?
both Maryland Association of Science Teachers and
❏ No ❏ Yes ID# ________________________________________
❏ Joint NSTA/USTA—$72/yr. Includes membership in ❏ Please remove my name and postal address from the mailing list
NSTA makes available to other organizations.
both Utah Science Teachers Association and NSTA
3. MEMBERSHIP JOURNALS Select the journal you
would like to receive as part of your membership:
4. GRADES (check all that apply)
❏ Pre-K ❏ 4th Grade ❏ 9th Grade
❏ Science & Children— ❏ Kindergarten ❏ 5th Grade ❏ 10th Grade
8 times a year; grades K–6 ❏ 1st Grade ❏ 6th Grade ❏ 11th Grade
❏ 2nd Grade ❏ 7th Grade ❏ 12th Grade
❏ Science Scope—
❏ 3rd Grade ❏ 8th Grade ❏ College
8 times a year; grades 6–9
❏ The Science Teacher—
9 times a year; grades 9–12 DISCIPLINES (check all that apply)
❏ Journal of College Science Teaching— ❏ Earth and Space Science ❏ Physical Science
7 times a year; college ❏ Biology/Life Science ❏ General Science
❏ Chemistry ❏ Computer Science
To subscribe to more than one journal, call NSTA Member ❏ Physics ❏ Tech Education
Services at 800-722-NSTA (6782) or 703-243-7100. ❏ Environmental Science ❏ Other______________________
6. Payment Method—Canadian and international members, please add $10 per journal per year. (U.S. Dollars)
❏ School Purchase Order enclosed. PO#_____________________________________
❏ Check enclosed, payable to NSTA (U.S. Dollars)
❏ Please charge my credit card: ❏ NSTA MasterCard** ❏ MasterCard ❏ VISA ❏ Discover
Card # _____________________________________________________________________________________ Expiration Date _______________________
Name on card __________________________________________________________ Signature ________________________________________________
Four Easy Ways to Join NSTA Membership dues are subject to change without notice.
*NSTA Reports is distributed to U.S. and Canadian members only.
1. Visit www.nsta.org
** Use of this card supports the science teaching profession. Call MBNA at
2. Fax your completed form to 703-243-3924 800-847-7378 for more information.
3. Mail your completed form with payment to NSTA, P.O. Box 90214,
Washington, DC 20090-0214.
4. Call NSTA Member Services at 800-722-NSTA (6782) or 703-243-7100.