Thursday, March 15, 2001 and Friday, March 16, 2001 Marriott River Center Hotel, San Antonio, Texas REGISTRATION FORM Name______________________________________________ DATE____________________ Organization___________________________________________________________________ Address (Home Organization ) Street_________________________________________________________________________ City / State / Zip________________________________________________________________ Phone ___________________________________ Fax _________________________________ E-Mail________________________________________________________________________ ACA Number for Member Discount_____________________________ SSN_______________ Special Needs__________________________________________________________________ Attending Full Workshop & Registering before 2/15/01 (Includes 2 continental breakfasts and the award's luncheon) _____Member(s) @ $110.00 = $__________ _____Non-Member (s) @ $120.00 = $__________ Full Workshop & Registering after 2/15/01 _____Member(s) @ $120.00 = $__________ _____Non-Member (s) @ $130.00 = $__________ Single Day _____3/15 _____3/16 _____Member(s) before 2/15/01 @ $ 65.00 = $__________ _____Member (s) after 2/15/01 @ $ 75.00 = $__________ _____Non-Member (s) before 2/15/01 @ $75.00 = $__________ _____Non-Member (s) after 2/15/01 @ $ 85.00 = $__________ TOTAL Investment $__________
Please send Registration with check payable to "NECA" to:
Dr. Mary Ann Radebach
NECA Workshop Chair
801 S. Pitt St. #330
Alexandria VA 22314
Federal ID # 510237963
Phone 703-683-0188
FAX 703-683-0858
E-mail mradebach@msn.com
We do not accept credit cards.