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<br />* REGIS1RATION FORM *
<br />
<br />1'l.'aM: Iype or print
<br />Name
<br />
<br />SI:x '" F
<br />
<br />Tille
<br />
<br />Cily or OrganiZ:llion
<br />
<br />Mailing Address
<br />
<br />Cily
<br />SI;Ue
<br />Tell'phone <<
<br />family Memhers AUending (No regblralionll.'e 1"l~luirL'll):
<br />Spouse full Name
<br />Child
<br />Child
<br />
<br />Zip
<br />
<br />Sex M F
<br />
<br />Age
<br />
<br />Age
<br />
<br />I. 0 111is is m)' fir,1 Congre,'ional Cily Confcrence.
<br />2. 0 1 :un ncwly delll'lllo ollicc,
<br />3.0 1 would like Ira\'cI as.,blancc from Ihc NLC Tr:lVcI Servit'cs (;roup.
<br />
<br />Ch('ck a/,/,Iica"'" (imj,'I''''/('(' Rl'Ri-'lmlioll fi'l! <l1It1 ('111('1' lolal fi'l.'S ill Ih('
<br />ri~bl /)C/IIc/ collllll1/:
<br />
<br />ADVANCE HESEHV,\T/ON I;EES
<br />IIh,llIIlI,.I.!('c/ ".' /'i41/1/l1ll' I.!. 199J)
<br />o $175 J)ir~ct I\lcml~r Fcc'
<br />o $275 A<;sod:llc I\knlher FL~'
<br />o $35n Non-Memher & Indirect Memher Fcc"
<br />o $350 Olher"
<br />
<br />SPECIAL EVENTS
<br />WIMG
<br />o $.iO
<br />0$35
<br />0$45
<br />
<br />s
<br />s
<br />s
<br />s
<br />
<br />Salunby l.ul1dll~>Il
<br />DirLocl I\kmher Ducs
<br />Non-Mcmher Dues
<br />
<br />s
<br />s
<br />s
<br />
<br />U,^I>ERSIIII' TltAINING INSTrnrm SEMINAHS
<br />I'ItlDAY, MARCil <;
<br />o $ 125 1.l':ltlinlllhl' (:hallenl(e "f Diwrsil)'
<br />o $125 J)cfcnsc CUlhalk, Arc lle:1I
<br />o $ 75 V:i:knmc In Pllhlic S.'r\'ire
<br />o $ 75 Effl'C1i\'c f,ktltl Rclalions
<br />
<br />s
<br />s
<br />S
<br />$
<br />
<br />SA'n IRIMY, MARCI I (,
<br />o $ 125 Ileill\'cnlinl( 'i,ur I",:a/ c,o\l'rnnI\.'111 S
<br />o S 125 Ill'C'(lIlnl'Ctin): Cilizens With 111cir Go\'erlllllenl S
<br />o $ 75 O'llllllul1il\' Plannin): l'lus S
<br />o S 75 Amidinl( the F1hil' Trap $
<br />o S 7<; :oM, 'i'u're (;oil1): to <::,11 Oil \\;I\hil1l(lolI S
<br />o S 7<; 111e Ilyn:"nil' 0/ l'ohlilall.i'lenin): S
<br />o S 75 E1hli\'e Alelha Ilclalions S
<br />
<br />CEIHlItJ\TE I>I\'EHSITY
<br />o S 1 <; SlInday Ilreakf:"1
<br />TOTAL
<br />
<br />s
<br />
<br />$
<br />
<br />.()n.o;ilt'It."C S.'W ;llft'f h.llftl.ln I!. I''''~
<br />"On.~ill. fl"l" t;.\H~ :lIll" h.hnl.ln Il. I'N.i
<br />
<br />I\lake dleek payahle 'or Ihe tola/ ;lInount '~'Ihe eonlt'fClKc rC):blratioll fces 10:
<br />Nt\'IlONt\1. U;,\(;I1E OJ' ClTlE';
<br />* Ce/llct'llali/", II'II('I~ 1/1/(\1 hI.' /",-,II//(/I'l,'d h)' Fehm:II'Y Il I'J'H "lit!
<br />all ('(/I/('('II"Ii",,-, "I''' '11"1''1.'1111 a 5, {II c//IIlt'lI/III""./"-,
<br />· S" It'/'1'/""'" "'~I\I"({lif III' "" ("'''C('/lOIII "'S 11#//1(. aU.'1"'.,/
<br />
<br />
<br />JJ()'Jn, A<:<:()MMODi\TION,<; HE<;J:IlVATlON HEl,lUliST
<br />(('k'a,,' 1)"1'" or prillll
<br />,", 1'1",,,, lIIake In)' 1..~l'I "'"',,alion a' illdil ,"nl'..'",,\,.
<br />U I do nol ,,'quirt, h.~d an'01I1I1Iod:llioll' :11 :IIIY oflhc Illtlel, listed 1,,'low.
<br />o I'Il'aS!." ('onl:Klllle rl'ganli1lg suill' inlonll:lliol1.
<br />~ 'Ii. a(TOIIIIII,..lall' your sl,,-:cial nl'l'ds, e,g., Whl~kh:lir alu'ssihlc
<br />~ r'H'IIIS, please t'l1llIal111ll' Conlnenec Ikgislralion Cenler.
<br />Spl.'C'ialllousing Rl~lul'st:
<br />
<br />.
<br />
<br />Ani\'al Dale
<br />I k'p:ulure dale
<br />
<br />_/-
<br />_/-
<br />
<br />Tillll'
<br />Tillie
<br />
<br />I WlI.I, III': SIIAllIN(i ,\IY 11001\1 \\"ITII:
<br />CO-OtHlp:1II1 Nallle
<br />Addres.s
<br />
<br />Cily
<br />SI:lIe
<br />Telephone I
<br />
<br />Zip
<br />
<br />CnEl>lT CAllI> AlfHlOIUZATION
<br />Credil Card COlllpany
<br />Card NlIIlIl..'r
<br />Expiralion D'lIl'
<br /><::ml I Jolder Signallm'
<br />1);lll'
<br />
<br />.111t' ~u: Cu"h."1t'lkl' Itl'J~i"'lr;Jhc". Ct...",:, i!" :IUlhnril'l'd In tI'o(' tilt. ;tlwnl'cmltn,.:lw.lUlt.'\. 1U\"J"Jfcl
<br />rl....t.'O.:lIion_ I t1ndl'I."";lIkllh:u INk' ni,.:ld-Oj """11 dUI.L.'t. \\iII ht' hiUl"tllhrllllJ.:h Ihi.. Llrtl illl.til In
<br />~hnw up '-or 1Il~ :I~"';":lk'tl hOI.l..in~ tin Iht.' llJlllinl1t..tl d;ut.' \lnk.'~.. t h;I\t.' nnn...lk'd tI1l fl''C,:n;J1i'tfl
<br />wilh Ih...olMttd :llll.:I.... -IN hours in :1t.h.a'll.t.',
<br />Intl"':IIt.. )CMtr li'....thoio: hOld with Ilk..' numhe:r I. l\umhc.:r ...!In hOld:" hUllIllu ');n (tult.., uf )uur
<br />prdl'rt.'nn.'. YIMIII1U" nHmhe:r :111 ho.d~,
<br />
<br />.
<br />
<br />CIIOICE IIOIU.
<br />
<br />SINGLE DOUBLE
<br />(AI 11M) III
<br />__~!.Il~~_~", __
<br />cC) IO,-I'IH Il"-I5'.I
<br />.!iKI l.!lI
<br />_.._--
<br />W) II';
<br />(I'I I,U
<br />(1'/ <J.~
<br />----
<br />Hil 105
<br />
<br />l)ul"-lI1l Plaza
<br />En~~,,-y ~O\\'
<br />lIilloll I h~d
<br />
<br />lIilloll'I()\\us
<br />
<br />( )lImi _~:,!!gl:~!~\'n
<br />l'ulhn:1Il Ilighland
<br />(.l~~lliIL~!~_
<br />\X;lshil1glon I\lal'riou
<br />
<br />11<;
<br />I,~.i
<br />lO,i
<br />105
<br />
<br />AU lII;l~lr (,nfit C :Inl.. ;lrt.' :ltn'l~t,tl ,lIlhe :lhO\(,ltlt,d..ln, 'f1"lIIclqw,.,.... ;antlor J,:lI:If;III'l't.'S, Y( tI'
<br />MI'''' UJMl'lrll' ANI> SI(iN "C1UJ)1T CAHIl AI 'TIIOIUZAIIU;-':" Sn:nUN AIK'\'[,
<br />
<br />1\11 ~'J\t'rnlltc'1I1 ptln 1t.1...... Ilfclt',.., lOtlc ht"" 1'1" brill" m..,II", "lIl'1l11l1t.t1ln 11"-' ;lpprnpti:llt'I"lId
<br />n,t -N "OU,,, III .Icl\;,,",. lit ;1Ifi\:11 t1;ut.. :lnclolll' "lllllnt It, .11'p"".11 h~. Ilk' 'll'ltd
<br />
<br />1'lt':I'o(' rt111rn IlIi..I"'1II \\llh ~otlr
<br />n'-).:i..IUflllfl p;l\nlt'lIll"
<br />
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<br />
<br />~IJ: f:1 "",.rt'lM. t' NcoJ:i...r:'lifMI
<br />':tOnh'r
<br />hullt... Inlern,llilln:d ^j'pllrl
<br />" ') I~I' 1-" i
<br />\\';I"'lin.~II'n.I)(. ,!ftllll
<br />I'h"ltt'l-o~, _~IX-II-l.'
<br />
<br />.."II"'t'"...illu'''
<br />\\illl... hdd:ll
<br />Iht.' \\';I...lliuglllll
<br />Ifillllll 1111",1 :1I1t1
<br />
<br />TI t\\ ".,....
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