NAWDP 2002 Annual Conference Presenter Registration Form by 64JB6CO


									    2012 NAWDP Youth Development Symposium Registration
First Name ___________________________________________ Last Name _____________________________________________
Phone_______________________________________________ Email of registrant_______________________________________
Are you a NAWDP Member?  Yes (Membership # _____________)  No
Please identify any special needs you have that require assistance (mobility, hearing, dietary requests, sight, etc)
 A list of participants will be provided to attendees and conference partners. If you do not want your information included, please contact NAWDP.

                                                  Registration Fee (November 14th-15th)
         Early Bird (before October 5th )                                     Regular (After October 5th )
         ___ NAWDP Member $260                                                ___ NAWDP Member $310
         ___ New or Renewing NAWDP Member* $335                               ___ New or Renewing NAWDP Member* $385
         ___ Non Member $350                                                  ___ Non Member $400

*includes 1 year NAWDP membership PLUS member registration fee

                            Optional Half Day Preconference Session (November 13th, 1:00pm- 5:00pm)
                                            Sessions are concurrent so please select only one session.

_____    Youth Recruitment and Motivation Made (Much!) Easier with Jodi Sue Kelly (additional $135 fee)
_____    VIRTUAL REALITIES – Social Media & Workforce Development in 2012 with Eric Rowles (additional $135 fee)

          Pre registration will be accepted until November 4st. After November 4st, registrations must be made on site.

                                                             Payment Information
 □ Check Enclosed □ Purchase Order (must be enclosed) Note: Registrations will not be processed until payment is received.
 □ Credit Card: (VISA, MasterCard, AMEX) Account Number: ___________________________________________________________________
         Exp. ___________                    Name on Card: _____________________________________________________________________
         Cardholder’s Signature: __________________________________________________________________________________________

                                               Cancellation Policy: Please Read Carefully!
A $75 cancellation fee will be charged for any registrations cancelled before 5:00 pm Eastern Time on October 5, 2012. After that date, no refunds
will be provided except for documented cases of medical emergency. Substitutions may be made at any time at no cost, but non-NAWDP members
will be billed the difference if replacing a member. Cancellations/substitutions must be submitted in writing and will not be accepted via phone.

                               Register online at or send registration with payment to:

         NAWDP  Attn: Conference Registrations  1133 19TH Street, NW – 4th Floor  Washington, DC 20036
                              Fax:   202.589.1799     Questions: 202.589.1790

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