ACA’s 71st Annual Convention & Expo • July 11-14, 2010 2010 Convention Registration Form Gaylord National on the Potomac • Washington, D.C. Complete one form per person. Complete as you would like your badge to appear. First Name ________________________________________ Last Name __________________________________________ Name for Badge ____________________________________ Member Number _____________________________________ Company _________________________________________ Title _______________________________________________ Mailing Address __________________________________________________________________________________________ City _____________________________________________ State ___________________ ZIP/Postal Code ___________ Country __________________________________________ E-mail (required) ______________________________________ Telephone ________________________________________ Fax _______________________________________________ q This is my first ACA Convention. ACA Convention Registration Fees ACA Convention Registration Early Bird (By 5/14) Regular (5/15-6/14) Late (On/After 6/15) • First Registrant (see information sheet for voting info)* q $ 776 q $ 862 q $ 949 • Additional Registrants (from same company & location) Save 15%! q $ 660 q $ 733 q $ 807 • Spouse/Guest (Meals ONLY) Name for badge _____________________ q $ 589 q $ 648 q $ 713 • One-Day Registration (Circle the day you will attend) q $ 466 q $ 518 q $ 569 Sunday Monday Tuesday • Nonmember – Full Convention Registration q $ 1,164 q $ 1,293 q $ 1,423 • Nonmember – One-Day Registration (Circle the day you will attend) q $ 698 q $ 776 q $ 854 Sunday Monday Tuesday President’s Banquet: Tuesday, July 13 q Yes, I am attending the President’s Banquet. q No, I will not be attending. Any changes to this section must be made by June 28. The deadline to receive a ticket for this event is June 28. FOR CONVENTION ATTENDEES ONLY. THIS FORM CANNOT BE PROCESSED WITHOUT COMPLETING THIS SECTION Legislative Day: Wednesday, July 14 q Yes, I plan on attending Ask Doctor Debt Makes a House (and Senate) Call FREE Campus ACA Seminar: Collection Floor Management: Sunday, July 11 q Register me. (Space is limited.) Page 1 Total (transfer to page 2 to calculate total payment) $ ____________ ACA Political Action Committee (ACPAC) Authorization is hereby given to ACPAC to solicit voluntary contributions from my company’s executive personnel for the year(s) indicated below. Authorization can be given to only one federal-level PAC affiliated with a trade association per calendar year. Signing this form does not obligate any of my company’s executive personnel or me to contribute to ACPAC; it only means we are willing to receive ACPAC materials. These authorizations expire on Dec. 31 of each year indicated. 2010 Signature of Officer_____________________________________ Title ________________________ Date _______________________ 2011 Signature of Officer_____________________________________ Title ________________________ Date _______________________ *For purposes of voting, this person will be considered the First Person Delegate. Mail or Fax Your Forms Today: Questions? Contact Campus ACA at +1(952) 926-6547 ACA International Convention Department, P.O. Box 390106, Go to http://www.acainternational.org/convention Minneapolis, MN 55439-0106 • Fax: +1(952) 922-6402 Or e-mail firstname.lastname@example.org Early-bird Registration Deadline: May 14, 2010 MAP (Members’ Attorney Program) Conference Early Bird (By 5/14) Regular (5/15-6/14) Late (On/After 6/15) • MAP Conference Only (MAP members/sponsors only) q $ 776 q $ 862 q $ 949 • MAP Additional Registrants (MAP member from same company & location) Save 15%! q $ 660 q $ 733 q $ 807 • MAP Conference & ACA Convention (Discounted price to attend both events.) q $ 1,242 q $ 1,379 q $ 1,518 • MAP Conference & ACA Convention Additional Registrants Save 15%! q $ 1,056 q $ 1,172 q $ 1,290 (From same company & location) • ACA member but not a MAP member/sponsor q $ 961 q $ 1,047 q $ 1,134 q Apply for CLE credits from my state. MUST register on or before May 7, 2010 to be eligible for CLE credits. Please write state(s)______________________________________. q Yes, I am attending the MAP special event on Monday, July 12. • Buy-in for President’s Banquet. (Must be purchased by June 28, 2010.) q $ 135 q $ 140 q $ 145 PPMS (Professional Practices Management System) Seminar: July 9-10 • PPMS Seminar First Registrant – Member q $ 549 q $ 549 q $ 549 • PPMS Additional Registrant – Member q $ 469 q $ 469 q $ 469 • PPMS – Nonmember q $ 687 q $ 687 q $ 687 Number of employees in your company ___________ CCCO (Credit & Collection Compliance Officer) Workshop: July 10 • CCCO Workshop First Registrant – Member q $ 239 q $ 239 q $ 265 • CCCO Workshop Additional Registrant – Member q $ 204 q $ 204 q $ 226 • CCCO Workshop – Nonmember q $ 332 q $ 332 q $ 332 Additional Tickets (Convention and MAP attendees and their guests) • Welcome Reception Tickets # of Tickets __________ q $ 90 q $ 95 q $ 100 • Passport to the World Reception Tickets # of Tickets __________ q $ 50 q $ 55 q $ 60 • President’s Banquet Tickets (by June 28) # of Tickets __________ q $ 135 q $ 140 q $ 145 Page 2 Total $ ____________ Payment: Payment required for processing. A confirmation e-mail will be sent to you. Total Page 1: $__________ Total Page 2: $__________ TOTAL: $__________ Signature _____________________________________ Date ______________ q Check payable in U.S. dollars to ACA International q Credit card: q MasterCard q Visa q American Express Card Number ______________________________________ Expiration Date _______________________________________ Print Cardholder’s Name ______________________________ Signature ___________________________________________ All credit card transactions are processed in U.S. dollars and are subject to the current exchange rates. International funds must be submitted in U.S. dollars. Special Needs and Dietary Requirements Additional fees may apply. ACA will do its best to accommodate your request as indicated below. Please indicate if needs are for: q Registered attendee q Guest q Vegetarian q Kosher: $75/meal q Special Diet q Vegan q Allergy Considerations ________________________ q Physical Needs Please see information page for cancellation policies, registration deadlines and registration fee categories. By registering for this event, I hereby acknowledge and agree that ACA International is not responsible for any injury, claim, liability or other cause of action of any kind based upon or resulting from my participation in this event. By attending this event, I authorize ACA to use my image in any promotional or informational material produced by or on behalf of ACA International. Any communication or material I do submit to ACA International will be treated as non-confidential and non-proprietary, and shall be deemed the property of and may be used by ACA International, or its affiliates, for any purpose including developing, producing and marketing products for commercial sale. ACA International may edit, copy, publish, distribute and otherwise use in any medium any submission to ACA International. Reg Code: L ACA’s 71st Annual Convention & Expo • July 11-14, 2010 Registration Information Gaylord National on the Potomac • Washington, D.C. Registration Fee Categories ACA Convention Registration First Registrant Includes: All meal functions, the Opening General Session, Identified as the first person who registers from an agency/ Welcome Reception, Monday and Tuesday breakfasts and affiliate/asset buying company. PDUs will be earned. lunches, Passport to the World Reception and the President’s Banquet, all convention education sessions, materials and Additional Registrants Collection Floor Management seminar, Expo 2010, plus legislative Identified as additional registrants from the same member activities on last day of convention. company and location as the First Registrant. Individuals will receive PDUs. To receive additional person discounts, MAP Conference Registration all registrants must be registered for the same event, i.e., Includes: Two breakfasts, two Expo Hall lunches, a flash drive Convention, MAP Conference, PPMS Seminar or CCCO Workshop. containing the session materials, CLE accreditation applied for upon request of those who register by May 7, 2010, the MAP Spouse/Guest Meal Package (Convention Only) special event, access to the Opening General Session at ACA’s Individuals attending convention meal functions with a Convention and access to the Welcome Reception in the Expo registered attendee. This category does not include access to the Hall at ACA’s Convention, plus legislative activities on last day of educational sessions or PDUs. convention. Daily Registration Convention and MAP Conference Combination Registration Includes the full day of events and meal functions for the day you Includes everything listed in both of the above descriptions. are registered. PPMS Registration Nonmembers Includes: Friday & Saturday continental breakfasts, breaks and Save on convention registration by joining ACA International. lunches, and seminar materials. To learn how to become a member, please contact the membership department at +1(952) 926-6547, or Credit and Collection Compliance Officer (CCCO) Workshop email@example.com. Registration Includes: Breaks, lunch and workshop materials. Voting Privileges at Cancellation Policy ACA’s Annual Meeting of the Membership • Full refund minus a $75 processing fee per registrant will be Agency/Affiliate/Asset Buyers: processed for convention or MAP Conference cancellations The first person from each company to register for convention is received by ACA in writing no later than June 14, 2010. eligible to vote. • A refund minus 30 percent of the registration fee will be processed per registrant for convention or MAP Conference Members’ Attorney Program/Creditors International Members: cancellations received by ACA in writing between June Each individual member attending convention/MAP Conference is 15–26. No refunds will be granted after June 27. However, eligible to vote. you may send a substitute from your company. No refunds will be given for no-shows. Early-Bird Registration Discounts: Need More Information? Register by May 14 and receive the best value for your money. Contact Campus ACA at +1(952) 926-6547. Registrations between May 15 and June 14 also receive savings Go to http://www.acainternational.org/convention off our “late fees.” Don’t Delay—Register Today! or e-mail firstname.lastname@example.org.