CONFERENCE 2009 REGISTRATION

CLASS REGISTRATION:

NAME _________________________________________________________

ADDRESS _____________________________________________________

________________________________________________________________

PHONE _____________________________________

EMAIL ADDRESS ______________________________________________

_____NIADA CONFERENCE REGISTRANT

_____NON-REGISTRANT

Class # 

Teacher    

Day(s)

of class

Length

of class

2nd choice

Class #

     

            day(s)

  
     

            day(s)

  
     

            day(s)

  
     

            day(s)

  
   

Total days >

            day(s)

  
   

Multiply by

corresponding

DAY RATE >

x

 
   

TOTAL due

For classes >

=$

 

Register online, or print and mail registration to Master Class Registrars:

Lynne & Gene Olson, Master Class Registrars

3426 West Lk Samm Pkwy NE

Redmond, WA 89052

425-885-6663

heimre@isomedia.com

Mail credit card info or make checks payable to NIADA, Inc.

Credit cards or PayPal are accepted for online payments.

PAYMENT INFO:

_____ CHECK (payable to NIADA, Inc.)

_____ PAYPAL (online at www.accessniada.com)

_____ CREDIT CARD

            _____ VISA

            _____ MASTERCARD

            CARD NUMBER __________________________________

            EXP. DATE _________________________________

            NAME AS IT APPEARS ON CARD _______________________________

            SIGNATURE____________________________________________________

________________________________________________________________________