140th NGAUS General Conference & Exhibition | August 24-27, 2018 New Orleans, LA NGAUS State Attendee Conference Registration Form **please submit registration form by 30 June 2018** MEMBER REGISTRATION Check one 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 $180 each. CONFERENCE EVENTS Check which of the following events you and/or your guest(s) will attend. NGAUS Golf Tournament 24 August ___Me ___Guest ___Both CG/WO Mixer (Hard Rock Cafe) 24 August ___Me ___Guest ___Both Fun Run - Riverwalk 25 August ___Me ___Guest ___Both Spouses Luncheon – LA School of Cooking 26 August ___Me ___Guest ___Both Retired/Separated Luncheon 26 August ___Me ___Guest ___Both Hospitality Night 26 August ___Me ___Guest ___Both States Dinner – Attire: Mardi Gras Casual 27 August ___Me ___Guest ___Both
$125 / person Free $25 / person Free $5 /person Free Free
ACCOMMODATIONS Your state’s hotel room block is at Hilton, 2 Poydras Street, New Orleans, LA 70130, 504-561-0500 $100 Hotel reservation deposit Check-in Date ____________________ Check-out Date____________________
OR
TRANSPORTATION Arrival Airline: ______________Flight #__________Arrival Time: ____________ Departure Airline: ______________Flight #__________Arrival Time: ____________ METHOD OF PAYMENT - Check or Credit Card Check # _________________________
Reservations made by NCNGA
____ I don’t need a hotel room
-$100 hotel deposit due upon sign-up -100% of add on event(s) due upon sign-up -1/2 of $180 registration fee/per person due upon sign-up -1/2 of $180 registration fee/per person due by 1 Aug -All credit card transactions subject to 3% transaction fee
~~ no refunds after 1 August 2018 ~~
Make check payable to NCNGA
CC Type ___________ CC # ______________________________ CVV __________ CC Expiration Date ________ Zip Code ___________ $____________ $___100_______ $____________ $____________ $____________
Total Cost for Conference Registration Fees Hotel Deposit Total Cost of Additional Conference Events Other Fee (i.e. Assn Hospitality Suite) Total Amount
Please note any special requirements or dietary restrictions:
RETURN THIS FORM WITH PAYMENT TO NCNGA Attn: John Ebbighausen, 7410 Chapel Hill Road, Raleigh, NC 27606-5047 or president@ncnga.org