Mail Completed Form With Payment To: Ms. Olivia Botello
                                                                    NOMAR Conference Chair
                                                                    P O Box  8724
                                                                    Corpus Christi, Texas  78468-8724

  Registration by fax: 361.356.6075/310.317.5958          Register by phone: 361.558.4751/310.317.5552

        

 

Print Conference Registration form

Your Name:___________________________________Title:___________________________________

Mailing Address:_______________________________________________________________________

Line 1:_______________________________________________________________________________

 

Line 2:_______________________________________________________________________________

  

City : _____________________________________________State: _____ Zip: ____________________

 

Billing Address: ( If different )

Line 1: ____________________________________________________________________________________

Line 2: ____________________________________________________________________________________

 

City : _____________________________________________ State: _____ Zip: ___________________

 

NOMAR Member?      If Yes, Chapter Name:______________________________________________

Agency/Company/Org.:___________________________________Attention:____________________

Home Phone:____________________________ E-Mail:______________________________________

Business Phone:___________________________Fax Number:_________________________________

REGISTRATION CATEGORY

( Please Check Appropriate Box. Note: Registration Does Not Include Lodging Costs. )

(  )$295.00 - Early Registration ( Postmarked on or before Aug 16, 2010 )

(  )$335.00 - Late Registration ( Postmarked after Aug 16, 2010 )

(  )$275.00 per person - Group Rate, 5 or more ( Only available if postmarked on or before Aug 5, 2010 )

(  )$150.00 per person - Full-time Student Rate            Print Student Registration form

(  )$200.00 - Workshops Only

METHOD OF PAYMENT ( Please Select the Appropriate Box. )

(  ) Visa or (  ) Mastercard     Card # ______-______-______-_______     Expires: ____ /_____

(  ) Check/Money Order     Signature (Required):______________________________________

(  ) Bill My Agency:     (Attach Authorization Copy)     Purchase Order #

CONFERENCE ADMINISTRATIVE USE ONLY

Purchased by (circle):   Individual;   Agency;   Other

Items given (circle):  Tickets;   Name Tag;   Registration Packet;   Other

Check/Money Order #:     Received _____ /_____ /_____

PO/Authorization #:________________________Invoice #:__________________________________

Receipt #:_________________________________Amount: $__________________________________