| Date
ex. _ _/ _ _/ _ _ _ _ |
| Participant Name (as you would like on name tag) |
First Name
Last Name
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Position/Title (as you would like on name tag) |
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| Organization Represented (as you would like on name tag) |
|
|
| |
| Preferred Mailing
Address |
City |
|
|
|
| State/Province |
Zip
Code |
Country |
|
|
|
|
Preferred Phone (please include country code) |
|
|
ex. 1-555-555-5555
|
Preferred E-Mail Address |
|
|
| |
| Conference Registration Fee (Choose One) |
|
- Conference registration fees include sit-down lunch and two tea breaks (with snacks) on February 25th, 26th,
28th, & 29th.
- To join ACA or renew your membership and benefit from membership discounts, complete this form and then
go to www.amcreativityassoc.org to become a member or renew your membership.
- We can only extend the extra special registration and hotel rates to a limited number of registrants. Act quickly
to secure your place.
Presenters may choose to participate in a special program free of charge on Wednesday, February 27.
Space is limited, so register early! |
|
Presenter Special Program Options (Indicate 1st, 2nd, & 3rd Choices) |
|
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|
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|
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Mid-Week Special Programs (Choose One) |
|
If you are booking a hotel room
through ACA, please fill out the information requested below. If you are not booking a hotel room
through ACA, please type "none" in the "For the Dates of:" box below and skip to "Total Owed."
Number of Nights Desired for Hotel Room (Choose One)
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| Room Type? (Choose One)
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| For the Dates of:
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Important: If registering for a room for two people at either hotel, indicate the name of the person who will be sharing your room
in the space below. Registration of both parties should be completed on the same day to confirm attendance of both participants.
|
Total Owed $
to be paid by (Choose
One)
- Registration is not completed until full payment
is received.
|
Please list anything more you would like conference planners to know (including ideas for conference programming;
any special dietary, mobility, visual, or hearing needs you may have; or other comments)?
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