Page 7 - NAGC Symposium on Equity for Black and Brown Gifted Students
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REGISTER ONLINE: www.nagc.org | EMAIL REGISTRATION FORM TO: adriane@nagc.org OR     Registration Form
       MAIL TO: NAGC, 1300 I Street NW, Suite 400E, Washington, DC 20005
       QUESTIONS? Call 202-785-4268 or email adriane@nagc.org

                                                                                                           USE ONE
                                                                                                          FORM PER

                                                                                                           PERSON





         ATTENDEE INFORMATION                               CANCELLATION POLICY:
                                                            Cancellations made prior to July 31 will receive a full refund.
           First time attendee at an                       No cancellations are accepted after August 1, 2021.
            NAGC Event.



         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                                         personal                   business


              Registration Rates               PAYMENT METHOD:
                                                  Check/Purchase Order (attach with form)

     Individual Member                              Mastercard    Visa
                                                                                               Discover
                                                                                 AMEX
     NAGC Member:                 $149

     NAGC Parent and              $75          Name on Card
        Student Member:

     Individual Non-Member                     Billing Address

     Non-Member                   $199         City                         State         ZIP Code
     Non-Member Parent            $99
       and Student
                                               Card Number

     Groups
     (5 or more) per person       $134              Exp. Date   CVV #

                                                I authorize NAGC to charge my credit card for $
             Online Registration


        https://bit.ly/NAGCEQUITY21                Signature


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