Nasstrac :: Online Registration Form

Online Registration Form

1. Registrant Information


First Name:
Last Name:
Name to appear on Badge:
Title:
Company Name:
Address:
City/State:
Zip:
Phone:
Fax:
E-mail:

In case of emergency contact:

Name:

Relationship:

Daytime Phone:

Evening Phone:

2. Registration

2. Registration Fees

Each participant must register individually (fees are shown for each individual).

Choose One:		NASSTRAC Members	Non-Members
	Full Conference:	$650	$850
	Day Rate:	$395	$495

Select You Membership Status

	I am A Regular Member
	I am An Associate Member
	I am Not A NASSTRAC Member

Guest Registration:

I am	bringing a guest
	not bringing a guest
Name of Guest/Spouse:

3. Payment Information

Card Type:

Visa

MasterCard

AMEX

Check (forthcoming)

Name on card:

Card Number:

Expire Date:

Credit card charges will be billed in U.S. dollars. The payee on your credit card statement will be identified as: NASSTRAC. Your institution will convert at the prevailing exchange rate. Cancellations are accepted with refunds made less $95 prior to September 2, 2005. Cancellations received on or after this date are not eligible for a refund.

NASSTRAC has negotiated a special room rate for single and double occupancy with the Sheraton Inner Harbor Hotel (U.S. $169, plus applicable state and local taxes). Hotel arrangements must be made directly with the hotel toll-free at 800-325-3535. To ensure room availability and this negotiated rate, make sure to make your reservations by Aug. 26, 2005.