Conference 2000 Fax/Mail Registration Form Leave a Comment / uncategorized / By childabuse 5th Annual Child Abuse Prevention Conference On The Front Lines-For The Children April 2-4, 2000 Albany Marriott Albany, New York FAX/MAIL REGISTRATION FORM PRINT AND FILL OUT THIS FORM FOR EACH REGISTRANT INTERNET REGISTRATION? check soon! CLICK HERE! TO REVIEW THE CONFERENCE Please use a separate form for each person registering. Photocopy as needed. Please print or type. Thank you. Return with check, purchase order or credit card number. (Registration does NOT include hotel reservation.) MAIL: NCPCA- NYS, 134 South Swan Street, Albany, NY 12210 FAX: 518-436-5889 (Credit card payment only) Inquiries: 518-445-1273 / [email protected] Name ____________________________________________________(please PRINT as it should appear on nametag) StreetAddress_____________________________________________/Agency __________________________________________ City________________________________________/State____/Zip_______________/County:___________________________ Phone ______________________/Fax_____________________/E-Mail__________________________ Check here if you do NOT want your name to appear on the Participant’s List that is enclosed in conference packets: ___ Special Needs: Communication____ Mobility____ Please specify need:____________________________________Special Meals: Kosher____ Vegetarian____ Diabetic____ Conference Registration Fees: PAYMENT: [Total Payment $ _____________ ] Please CIRCLE the fee that applies to you*———> Check, payable to NCPCA-NYS, # ___________ ] Purchase Order # __________________________ ] CREDIT CARD: Mastercard __ VISA __ Card # _______________________Exp/____/_____/ Name on card____________________________ Signature: ______________________________________ CANCELLATION: Refunds less a $20/person processing fee, will be issued ONLY for written cancellations postmarked or faxed by Monday, March 2, 2000. NO-SHOWS will be billed. *SAVE NOW- REGISTER BY February 29, 2000! FULL CONFERENCE By 2/29 Early Bird $175 After 2/29 $200 nn nn nn ONE DAY: Check day: Monday Tuesday By 2/29 $90 As of 2/29 $100 nn $90 $100 Sunday Only By 2/29 $70 After 2/29 $80 nn $70 $ 80 | HOME | INDEX | WORKSHOPS | SPECIAL EVENTS | REGISTRATION | ACCOMMODATIONS | CAP NETWORK | CONTACT US |
