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SAMPLE CONFERENCE REGISTRATION FORM TEMPLATE - CUSTOMIZE AND PRINT INSTANTLY

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SAMPLE CONFERENCE REGISTRATION FORM TEMPLATE - CUSTOMIZE AND PRINT INSTANTLY Powered By Docstoc
					REGISTRATION FORM
Contact Insert Hotel Name hotel directly for reservations. Ph. 1-800-000-0000 This registration form is available online in a PDF file which can be filled out on your computer. http://yourwebsite.com DATES TO REMEMBER Insert Date - Hotel room block reservation deadline. Rooms may still be available after that date but not at the conference rate. Insert Date - Date on which early registration discounts end. See registration fee schedule below. Insert Date – Date after which no full refunds for cancellation of registration. Your handbook will be sent to you after the conference. Insert Date - Advance registration deadline. All registrations after DATE must be completed at the conference. After DATE, please send an e-mail to youremail@companyname.com of your intent to attend and I will try to ensure that you receive all conference benefits. Walk-in registrations are accepted but we cannot guarantee that we will have seats or conference materials available at the conference. CONFERENCE HANDBOOKS – Don’t forget to make your choice; please read carefully to make your best choice Each attendee has the option of (1) a handbook of the written presentation materials or (2) a CD-ROM with the written materials in PDF files. There will be a section of each conference room equipped with power strips to allow viewing of the CD on your laptop. The hotel provides a shipping service to ship your printed handbooks home after the conference. If you prefer to use FedEx, please bring your account number. Because there are last minute-submitted papers, the CD provided at the conference will not have all submitted papers on it. Therefore, after the conference, a new, complete CD will be sent to attendees who chose to receive the handbook on CD. Extra printed conference handbooks are available for $90 each (see order form on the other side). After the conference, extra copies of the complete handbooks will also be available on CD-ROM for $45 each. Please choose one: ___ I want the printed version of the conference handbook. Additional copies may be purchased on the other side of this form. ___ I want the CD-ROM version of the handbook. No printed copies of the written materials or outlines will be included.

PERSONAL INFORMATION
Each attendee must complete a separate registration form but multiple registrations may be paid in a single payment.

___Mr./___ Ms. _____________________________________________________________________________________________ Name (Please print or type) ___________________________________________________________________________________________________________ Firm ___________________________________________________________________________________________________________ Street ___________________________________________________________________________________________________________ City State Zip Phone ___________________________________________________________________________________________________________
E-mail (please print clearly)

Personal Preferences
___ Dietary requests (including vegan/vegetarian meals) must be submitted at least 24 hours before the conference. I have need for physical or dietary assistance: ___ I would like to seek CLE credit in the following states: ___ I would like to seek education credit for another profession (credit type and state):

REGISTRATION FEES
Registrations postmarked before Date $ $ $ $ Registrations postmarked after Date $ $ $ $ Total registration fees ____________(a)
* Non-members may join at this time and receive the member discount on the registration fee for this conference and in 2009. ** Non-ORGNAME Student fee includes a one year ORG NAME student membership. ”Student” means person currently enrolled in educational institution above the high school level.

Member Non- Member* Student** Member Non- Student**

ADDITIONAL REGISTRATION ITEMS
Spouse/Guest of registered attendee, for attending all food/beverage events - $50 each Quantity____ x $50= Total ________(1)

___Mr./___ Ms. _____________________________________________________________________________________________ Name of spouse/guest (Please print or type) ___Mr./___ Ms. _____________________________________________________________________________________________ Name of spouse/guest (Please print or type)

Extra Handbooks
Additional Conference materials on CD (sent after conference) - $45 each Additional Conference materials in printed Handbook (sent after conference) - $90 each Quantity___ x $45 = Quantity___ x $90 = Total _______(2) Total _______(3)

Total additional fees (add (1), (2) and (3)) ____________(b)

2009 ORG NAME MEMBERSHIP DUES

New memberships effective immediately and continue through the end of 2009. This is a ___new/___renewal membership for 2009. ___Regular ..................................................................................................................................$90 ___Regular with residence outside North America with e-mail subscription to newsletter ........$90 ___Regular with residence outside North America with print subscription to newsletter .........$125 ___Student ...................................................................................................................................$30 ___New Practitioner** ................................................................................................................$60 ___Sustaining ............................................................................................................................$175 ___Institutional (up to 3 individual members)***.....................................................................$250 Total 2009 Membership Dues __________(c) Total Amount enclosed (add (a), (b) and (c)) ______________

**This membership level is available to members who are, as of January 1, 2009, within three years after graduation from a college or university or law school. ***Institutional members may include up to three individual members. Please provide separate registration/membership informat ion for each individual.

Payment information ___ Check enclosed for $_____________
___ Please charge to my credit card: ___Visa ___Mastercard ___American Express ___Discover Card number_________________________________________________________________________ Exp. Date ______/______ Cvv #( 3 or 4 digits by signature block or on front of card) _____________

Card billing address (number, street and zip only), if different from registrant’s address

Send order form to COMPANY NAME AND MAILING ADDRESS

Or Fax to: 800-000-0000


				
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