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ASNE
Day 2005
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April 26-27, 2005
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Virginia Beach Pavilion
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MAIL TO: ASNE • Attn: ASNE
Day 2005 • 1452 Duke Street, Alexandria, VA 22314-3458 or FAX
TO: (703) 836-7491
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Please
Print Clearly or Type All Information
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| Full Name: | Name for Badge |
| Position: | |
| Organization: | |
| Address: | E-Mail: |
| City, State ZIP: | Phone: |
| Special Needs: | Fax: |
| Full Registration includes: | |||||
| Technical Program (both days) |
Luncheon (Tuesday)
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| Exhibits |
Exhibit Hall Luncheon (Wednesday)
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| Proceedings on CD-ROM | |||||
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REGISTRATION
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| Member |
@$250: (___)
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Member (Under 30) |
@$150: (___)
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| Non-Member |
@$360: (___)
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Non-Member (Under 30) |
@$260: (___)
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| Registration & Membership |
@$345: (___)
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Registration & Membership |
@$245: (___)
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| Extra Proceedings |
@ $ 25: (___)
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Extra Proceedings |
@ $ 25: (___)
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| Late Fee (After April 11) |
@ $ 50: (___)
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Late Fee (After April 11) |
@ $ 50: (___)
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| Total Amount Enclosed |
$ __________
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Total Amount Enclosed |
$ __________
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SPEAKERS,
MODERATORS, AND PAPER PRESENTERS
Please request a "Presenter Registration Form" at 703-836-6727 ext 20 (Nikki Johnson) |
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Advance Payment is Required -
Please check method of payment:
[ ] I have enclosed my check
or money order
[ ] Approved Purchase Order
is attached
[ ] MasterCard [ ] VISA
[ ] American Express [ ] Discover
Credit Card Number:
_________________________________
Signature:
Exp Date: / |
CANCELLATIONS, TRANSFERS,
AND REFUNDS
Cancellations must be in writing and cannot be accepted after April 11, 2005 A $50 administrative fee will be subtracted from all refunds through April 11 , 2005, and a $25 fee will be applied to all transfers. |
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Point of Contact for Registration is Nikki Johnson (703) 836-6727 |
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Sign
up for Membership in conjunction with the symposium and be eligible
to win a digital camera!
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