Page 17 - NAGC 67th Annual Convention Reimagined! Preliminary Program

REGISTER ONLINE: www.nagc.org | EMAIL REGISTRATION FORM TO: adriane@nagc.org OR USE ONE
MAIL TO: NAGC, 1331 H Street NW, Suite 1001, Washington, DC 20005 FORM PER
QUESTIONS? Call 202-785-4268 or email adriane@nagc.org PERSON

67th Annual Convention | November 12-17 , 2020

A TTENDEE INFORMATION

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

First Name Last Name

Professional Title

School/Organization

Mailing Address: check o home work

City, State, ZIP Code

Phone: check o home work

Email: check o home work

PA YMENT METHOD:
CANCELLATION/CHANGE/
SUBSTITUTION POLICY: o Check/Purchase Order (attach with form)
Cancellations received September 12 - 30 o Mastercard o Visa o AMEX o Discover
will incur a $100 processing fee. No
refunds will be provided after October 1.
Changes in attendees can be made Name on Card
without charge.
Billing Address
PHOTO RELEASE:
Photographs and/or video footage taken at
NAGC events may be used for publicity on City State ZIP Code
www.nagc.org, social media, or in print
publications. Registration grants
permission for NAGC to publish photos, Card Number
video, and/or comments of attendees,
unless a letter stating that registrant “does
not grant NAGC permission to use personal Exp. Date CVV #
image or likeness” accompanies I authorize NAGC to charge my credit card for $
registration form.

Signature

#NAGC20 RegisterNo
www.nagc.org