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| Name: * | |||||||||||||
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| Title: * | |||||||||||||
| Company: * | |||||||||||||
| Street Address: * | |||||||||||||
| City & State: * | |||||||||||||
| Zip Code: * | |||||||||||||
| Phone Number: * | |||||||||||||
| Fax Number: | |||||||||||||
| Email Address: * | If you do not have an email address, enter the word "none" |
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| Do you need special accommodations? If yes, please describe. | |||||||||||||
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| Please indicate which Topic from
Session 1 you plan on attending.
Click here for more
details (opens a new window) |
Session 1 Topics (choose one)
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| Please indicate which Topic from
Session 2 you plan on attending.
Click here for more
details (opens a new window) |
Session 2 Topics (choose one)
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| Please indicate which Topic from
Session 3 you plan on attending.
Click here for more
details (opens a new window) |
Session 3 Topics (choose one)
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| What is your affiliation? (choose one) |
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| Are you planning to attend the Evening Networking Event? |
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* Required Field
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Registration Fee and Payment |
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| Fee
Amount:
$150.00 Member $200.00 Non-Member |
Make
check payable to:
Northstar Chapter Registration Fee Due September 21 |
Mail
your check to:
NCS Pearson, Inc. |
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