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Alabama Athletic Trainers Association Annual Meeting Registration

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Alabama Athletic Trainers Association Annual Meeting Registration Powered By Docstoc
					                                       Alabama Athletic Trainers’ Association
                                         Annual Meeting Registration Form
                                           Sandestin Golf & Beach Resort
                                             Sandestin, FL 32550-7268
                                                 May 13-16, 2010
                                               Reservation Fax: 850-267-8221
                                                 Reservations: 850-267-8000
                                              Group Reservations: 800-267-8000
                                                    www.sandestin.com
                                                    (When registering give them ALATA’s
                                          Group/Promo Code: ALATA, You can now register online
                                            using the above Group/Promo code on their website)


Name
 (Please Print)                   Last                                    First                 Middle Initial                 Badge name

Place of Employment

Credentials

Address (Line 1)

Address (Line 2)


                  City                          State                     Zip                                          Email


                  Primary phone                                    Cell Phone                                              Fax

ALATA Member                Yes                  No        NATA Membership#                                       Non-NATA Member

     Registration Fees: Please check the appropriate box. *(Must be received by 5/1/10)

Course Fee Received prior to 5/1/10                                                                                       $100.00
Registration Received after 5/1/10                                                                                        $130.00
On-site Registration                                                                                                      $150.00
Student Registration (GA’s included)                                                                                       $45.00
Alabama residents that are not ALATA members                                                                               $10.00
Donation to the NATA Research and Education Foundation:
Anyone wishing to make a NATA-REF donation may do so by including the amount noted at the right to their total.    $
Donation to the ALATA Scholarship fund                                                                             $
Total Enclosed (Please make checks payable to ALATA)                                                               $
Total:                                                                                                             $

*Please call Sandestin Golf and Beach Resort to reserve your room by April 22, 2010.
*If there are any questions, please contact course chairman, Mike Jones @ 205-975-9257 or mail to:
jones65@uab.edu
                             Please return this form with check payable to ALATA to:
                                          Attn: Britney Wilkes, Secretary
                                                      ALATA
                                               1600 7th Avenue South
                                                     ACC 402
                                              Birmingham, AL 35233