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Please use this form to register for the 2008 AzAADAC State Conference
This is a CREDIT CARD ONLY registration
To register by mail please dowload the conference brochure click on this lind and follow the instructions for registering and mailing.
* First Name
* Last Name
* Email Address
Supplying your email address is necessary for us to send you a reply.
Title
* Organization
* Street Address
* City, State Zip
* Phone
I Prefer Vegetarian Meals
I Prefer Vegan Meals
* Days Attending
Pre-Conference
Both Days
Sept 26
Sept 27
Are are you a member of AzAADAC
Yes
No
I am a student
Conference Registration
Early Bird (by Aug 21)
Regular (Aug 22 - Sept 25)
On-Site
Pre-Conference
$75
$90
$110
Members
Both Days
$125
$150
$175
Sept 26 Only
$75
$90
$110
Sept 27 Only
$75
$90
$110
Non-Members
Both Days
$175
$195
$225
Sept 26 Only
$100
$115
$125
Sept 27 Only
$100
$115
$125
Students
(w/ valid ID or letter)
Both Days
$90
$110
$140
Total Registration Fee:
Credit Card Info
Card Type:
VISA
MasterCard
AMEX
Card number:
no dashes please
Expiration Date (mm/yy):
/
please enter expiration date
mm/yy example 09/08
* I hereby authorize AzAADAC Conference 2008 to Charge $
to my Credit Card
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Fields marked with an
*
are required
Please type your comments, and or question in the box below:
Press the submit button to send to the AzAADAC State Conference Chairperson