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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