139th NGAUS General Conference & Exhibition | September 7-10 Louisville, KY NGAUS State Attendee Conference Registration Form MEMBER REGISTRATION Check any if applicable: ___ Retiree ___ Current TAG ___ Former TAG ___ I would like to be considered as a delegate for my state Full Name _____________________________________________________________ Name on Badge _____________________________ (Include Rank/Title/Prefix/Suffix if applicable)
Address ________________________________________________________City ____________________ State _____ Zip __________ E-mail ________________________________________ Phone _________________ _ NGAUS Membership ID #___________________ By providing an e-mail address, NGAUS will be able to send to you conference updates, special event invitations, etc.
SPOUSE OR GUEST REGISTRATION Check one if applicable: ___Spouse
___ Guest
Full Name _____________________________________________________________ Name on Badge __________________________ (Include Rank/Title/Prefix/Suffix if applicable)
NGAUS REGISTRATION FEE: NGAUS member and member’s guest pay $200 each($180 for convention+$20for hospitality suite). (Refunds less a $15.00 administration fee will be granted for requests received in writing prior to 11:59 PM EST July 21, 2017. All refunds will be processed after the conclusion of the conference. After July 21, 2017 all sales are final and no refunds will be processed.) CONFERENCE EVENTS Check which of the following events you and/or your guest(s) will attend. NGAUS Golf Tournament September 7 ___Me ___Guest ___Both CG/WO Mixer September 7 ___Me ___Guest ___Both Fun Run September 8 ___Me ___Guest ___Both Spouses Luncheon September 9 ___Me ___Guest ___Both Warrant Officer Luncheon September 9 ___Me ___Guest ___Both Retired/Separated Luncheon September 9 ___Me ___Guest ___Both States Dinner September 10 ___Me ___Guest ___Both
$125/person Free $20/person Free Free $5/person Free
ACCOMMODATIONS Your state’s hotel room block is at ___Marriott____________. A$100 deposit is required to reserve a room. Check-in Date ____________________ Check-out Date____________________ OR ____ I don’t need a hotel room TRANSPORTATION Arrival Airline: ______________Flight #__________Arrival Time: ____________ Departure Airline: ______________Flight #__________Arrival Time: ____________ METHOD OF PAYMENT - Check or Credit Card
-$100 hotel deposit due upon sign-up -100% of add on event(s) due upon sign-up -$200 registration fee/per person due upon sign-up -All credit card transactions subject to 3% transaction fee
~~ no refunds after 21 July 2017 ~~
Check # _________________________
Make check payable to NCNGA
CC Type ___________ CC # ______________________________ CVV __________ CC Expiration Date ________ Zip Code ___________ $____________ $____________ $____________ $____________ $____________
Total Cost for Conference Registration Fees ($200/person) Hotel Deposit
Please note any special requirements or dietary restrictions:
Total Cost of Additional Conference Events Other Fee (i.e. Assn Hospitality Suite)
Total Amount
RETURN THIS FORM WITH PAYMENT TO NCNGA Attn: Mark Almond, 7410 Chapel Hill Road, Raleigh, NC 27606-5047 or nc.ngaus@gmail.com