2004 NAPC Conference Registration Form

Please complete a separate form for each participant from your organization.

To register: (Please do not fax.) 

Mail your completed forms, with your check or credit card information, to:  
Conference, NAPC, 11118 Ferndale Road, Dallas, TX 75238.

... or ... 	 
	
E-mail your registration information, if you plan to use a credit card. 

You may type your answers into this file, save, and email it to conference@communityplanning.org as a file enclosure. Be sure to include ALL the information requested in the form. 

Or, copy-and-paste the information from the form below directly into an email message, add your information, and send.  

Type "conference registration" in the subject line. 
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PARTICIPANT INFORMATION:

Name:
Title:
Organization: 
Email:
Website: 
Address:
City, state, zip:  
Phone:
Fax:

CONFERENCE REGISTRATION:

__ Check here if you will be attending the May 6 pre-conference meeting on 2-1-1.  (There is no additional fee, but you do need to pre-register here.) 	
  
Please write or type the subtotal amounts to the right of the appropriate categories, then add the total.

Conference Fee (see rates below):
Seafood Fest:
NAPC Dues (see note below):
TOTAL Payment:

PAYING BY:     

Check:__   

- or -  Credit Card:  __Visa    __MasterCard   __Amer. Express   __Discover

Name on card: 
Card number:	
Expiration date: 
Signature: 

SPECIAL NEEDS? (Please describe:)

Thank you!  Looking forward to seeing you in Norfolk!

National Association of Planning Councils
11118 Ferndale Road  
Dallas, TX 75238  
1-800-795-9834
Email:  conference@communityplanning.org  
Online:  www.communityplanning.org

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Rate:   For: 
 
$298	Non-member's conference fee - per person   
$248	Member's conference fee - first participant	
$198	Member's conference fee - additional participant from the same member organization 
$ 45	Seafood Fest (Saturday night celebration ... optional ... paid for in advance with registration)

NAPC dues ... join now, or renew your membership, and qualify for the "member" conference rate! See: "Join NAPC" on www.communityplanning.org for dues and special introductory offer.	                                                                                                                                                                                    
(Note: your credit statement will say "Clark/Jump" ... a business is contributing use of their secure server for NAPC's conference registration, for your convenience.)

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