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Joint
Seabasing Conference 2005
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January 27-28, 2005
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Marriott Crystal Gateway, Arlington,
Virginia
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MAIL TO: ASNE • Attn: HPWS
• 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: |
| Registration includes: | ||||
| Technical Program on day(s) of registration | ||||
| Lunch on day(s) of registration | ||||
| Exhibits | ||||
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Full
Registration
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One-Day
Speaker Registration
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| Member |
@$300: (___)
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I will present on: Thu [__] Fri [__]
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| Non-Member |
@$410: (___)
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Registration is free on the day of
presentation. If you are only presenting on one day and would also like
to attend the other day, please so indicate to the left.
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| Registration & Membership |
@$395: (___)
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| Presenter (attending additional day) |
@$200: (___)
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| Late Fee (After January 14) |
@ $ 50: (___)
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| Total Amount Enclosed |
$ __________
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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 January 14, 2005 A $50 administrative fee will be subtracted from all refunds through January 14, 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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