NENA Annual Conference June 21 -25, 1998
Registration Form
Please download this form and print or typeyour information. Please register just one attendee and guest perform.
Attendee Information | ||
Name | Last _____________________________________________ | First __________________________________ |
(as it should appear on your name badge) | ||
NENA Membership Number | ____________ | |
First Time Annual Conference Attendee |
_____ Yes | |
Title | _________________________________________________ | |
Agency/Company | _________________________________________________ | |
Address | _________________________________________________ | |
City, State/Province, Zip Code | _________________________________________________ | |
phone (work) | Phone ___________________________________ | Fax _______________________________ |
Spouse/Guest | Name ____________________________________________ | |
(As it should appear on his/her name badge) |
Attendee Information – Pleasecircle just ONE in each section
Employer Category | ||
01 9-1-1 Board | 05 Consultant Services | 09 Fire Department |
02 Government Board | 06 Equipment Vendor/Distributor | 10 EMS |
03 Telephone Company | 07 Equip. Manufacturer/Developer | 11 Other ______________ |
04 Independent System Provider | 08 Police Department |
Job Classification | ||
01Director, Agency Head, Supervisor | 06 Education & Training | 11 Other ______________ |
02 Marketing/Sales | 07 Emerg. Responder, Service Provider | 12 9-1-1 Product Mgr. |
03 Project Engineer/Systems Designer | 08 Dispatcher/Call Taker/Radio Opera. | 13 County Elected Official |
04 DB Mgr./DB Developer/Addressing | 09 Equip. Installation/System Install. | |
05 Data Base/Clerical | 10 9-1-1 Coordinator |
Registration Fees
Registration fees for NENA Members andNon-members include: all educational sessions, admittance toexhibit area, registration materials, Welcome Reception,refreshments & Wednesday night party & dinner.Non-members also receive a one year membership in the association($60). Spouse or Guest Registration includes registrationmaterials, Welcome Reception, and Wednesday night party &dinner.
Tuesday Only Day Pass registration includes: Tuesday educationalsessions, admittance to exhibit area on Tuesday, and limitedregistration maters. Non-member Day Pass Registration alsoincludes a 1-year NENA members – a $60 value!
Attendee Category | Early Registration | (postmarked | Regular Registration | (postmarked | ||||
NENA Member | _____ $325 | by 5/15/98) | _____ $355 | after 5/15/98) | ||||
Non-Member | _____ $385 | _____ $415 |
Referred by NENA member:___________________________________________
Spouse/Guest | _____ $125 | _____ $125 |
NOTE: This category limited to guest or spouse notemployed or working in the 9-1-1 industry
Tuesday Only Day Pass | _____ $65 non-members | _____ $20 members | _____ $75 non-members | _____$25 members |
Pre-Conference Courses – Sunday, June21, 1998
The 9-1-1 Puzzle | _____ $195 | _____ $195 | ||||||||||||
E9-1-1 Data Base | _____ $195 | _____ $195 | ||||||||||||
Managing the 9-1-1 Center | _____ $195 | _____ $195 |
Optional Tours:
Cincinnati Highlight Cruise | Sunday, June 21 | I would like _____ tickets at $57 each = ___________ | ||
United States Air Force Museum | Tuesday, June 23 | I would like _____ tickets at $25 each = ___________ |
Payment Information
______ | Check Enclosed, Payable to NENA (US Funds) | |
47849 Papermill Rd; Coshocton, OH 43812-9724 | ||
______ | VISA | ______ | MasterCard | ______ | American Express | Fax Completed Registration Form to (740) 622-2090 |
Credit Card Number | __________________________________ | Expiration Date | ________ |
Signature | __________________________________ |
Total your costs here:
Attendee Registration | __________ |
Spouse/Guest Registration | __________ |
Tuesday Only Day Pass | __________ |
Course Fee Total | __________ |
Tour Ticket Total | __________ |
TOTAL ENCLOSED | __________ |
WE ARE UNABLE TO ACCEPT PHONE REGISTRATIONS.CANCELLATIONS RECEIVED BEFORE MAY 15, 1998 WILLBE CHARGED A $50 FEE.
NO REFUNDS CAN BE GIVEN AFTER THIS DATE.