Page 13 - NAGC21 Program at-a-glance

REGISTER ONLINE: www.nagc.org | EMAIL REGISTRATION FORM TO: adriane@nagc.org OR USE ONE

MAIL TO: NAGC, 1300 I Street NW, Suite 400E, Washington, DC 20005 FORM PER
QUESTIONS? Call 202-785-4268 or email adriane@nagc.org PERSON

ATTENDEE INFORMATION

 I am a first-time attendee. I am a presenter. I wish to be excluded from exhibitor mailings.

First Name Last Name

Professional Title

School/Organization

Mailing Address: (check one) home work

City, State, ZIP Code

Phone: (check one) home work

Email: (check one) personal business

CANCELLATION/CHANGE/ PAYMENT METHOD:
SUBSTITUTION POLICY: Check/Purchase Order (attach with form)
Cancellations received September 12 - 30 will Mastercard
AMEX
Discover
incur a $100 processing fee. No refunds will be  Visa  

provided after September 30. Changes in
attendees can be made without charge. Name on Card

PHOTO RELEASE:
Photographs and/or video footage taken at Billing Address
NAGC events may be used for publicity on
www.nagc.org, social media, or in print City State ZIP Code
publications. Registration grants permission for

NAGC to publish photos, video, and/or
comments of attendees, unless a letter stating Card Number
that registrant “does not grant NAGC

permission to use personal image or likeness” Exp. Date CVV #
accompanies registration form. I authorize NAGC to charge my credit card for $

Signature

ACCESS SUPPORT: NAGC is committed to making our meetings a safe, welcoming, and inclusive space for everyone. Please indicate what access support or
accommodations you will need to participate in this year’s national convention. Based upon the request, you will receive communications prior to convention
regarding access support information.

Thank you for supporting NAGC! We look forward to seeing you in Colorado!

Online Registration: bit.ly/NAGCUNITED2021