Page 7 - NAGC Symposium on Equity for Black and Brown Gifted Students

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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