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2007 CONFERENCE REGISTRATION FORM
The Early Bird registration ($185/person general or youth) ends April 16, 2007. After that date, the
Registration fee is $200. Late/On-Site Registration (after July 2, 2007) is $250 with no guarantee
that all conference materials will be available at check-in. We request that all conference
attendees pre-register to assure the availablity of all conference materials. To register, please
complete this registration form and return it with payment to NIJC (see below). Confirmation of
your conference registration will be mailed to you. Please complete a separate registration form for
each conference participant. If you have any questions, please contact NIJC staff at (707)
579-5507 or e-mail us at email@example.com.
Please Print Clearly ( Information is used for your name tag)
Mr. Ms. First Name: Last Name:
General Youth (17 and under)
City: State AL Zip:
Phone Number Fax Number
Please indicate any special needs (i.e. Dietary or Disability):
Payment Type: Early Bird Standard Registration Late/On-Site Registration
Amount: $185 $200 $250
Deadline: Before: 4/16/07 After: 4/16/07 After 7/2/07
Check or Money Order payable to NIJC Check or Money Order #
Credit Card Visa Mastercard American Express Discover
Card Number Exp. Date
Return this form to NIJC by fax (707) 579-9019 or mail to NIJC, 5250 Aero Drive, Santa Rosa, CA 95403.
We look forward to meeting you at this very important conference.