CONFERENCE 2009 REGISTRATION

CONFERENCE REGISTRATION:

NAME _________________________________________________________

ADDRESS _____________________________________________________

________________________________________________________________

PHONE _____________________________________

EMAIL ADDRESS ______________________________________________

_____NIADA ARTIST MEMBER

_____NIADA PATRON MEMBER

_____NIADA ACADEMIC MEMBER

_____VISITING ARTIST

_____FRIEND

How did you hear about this conference? (Internet, magazine, newspaper article, word of mouth, email invitation or other) _____________________________________________________

MEMBER STATUS

Conference fee

Conference fee

after Aug. 1

ENTER conference

fee AMOUNT below

NIADA member

$250

$265

  

Non-member

$275

$290

DEDUCTIONS:

Enter amount of time

You are in class on

Fri. and/or Sat. only >

                    Day(s)

multiply

X $40     =    >

subtract  from fee above

-$
     

$

TOTAL due

for conference fee

Register online, or print and mail registration to Registrar:

Barbara Baker, NIADA Registrar

9809 W. 99th Terrace

Overland Park, KS 66212

913-888-7278

BBaker3565@aol.com

Mail credit card info or make checks payable to NIADA, Inc.

Credit cards or PayPal are accepted for online payments.

PAYMENT INFO:

_____ CHECK (payable to NIADA, Inc.)

_____ PAYPAL (online at www.accessniada.com)

_____ CREDIT CARD

            _____ VISA

            _____ MASTERCARD

            CARD NUMBER __________________________________

            EXP. DATE _________________________________

            NAME AS IT APPEARS ON CARD _______________________________

            SIGNATURE____________________________________________________

________________________________________________________________________