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NPGA SOUTHEASTERN MARKETER REGISTRATION


          NPGA Southeastern States Marketer Members registering at the full conference rate of $220 receive two
          complimentary employee registrations. This exclusive offer provides a savings of over $440! This offer is
          available exclusively to marketers within the seven southeastern host states (AL, FL, GA, MS, NC, SC, and TN).
          Marketers must be a current member of the National Propane Gas Association. One individual must register at the
          full conference package rate of $220 to receive the two complimentary employee registrations. Complimentary
          employee registrations include access to all three show days. Complimentary employee registrations must be used
          by an employee of the member company located within the southeastern states.
                        All forms due Friday, April 5, 2019; pre-registration is required for this discount.

           PRIMARY REGISTRANT:

          First Name:                                              Last Name:
          Marketer Member Company:                                                                     ______
          Title:
          Address:
          City:                                                    State:           Zip Code:
          Phone:                                                 Email:




            COMPLIMENTARY EMPLOYEE REGISTRANTS (ALL FIELDS REQUIRED):




          1.     First Name:                                       Last Name:
                 Title:                                            Email:
          2.     First Name:                                       Last Name:
                 Title:                                            Email:


           PAYENT INFORMATION:

          Payment Amount: $220 (includes one full conference registration and two complimentary employee registrations)
           Check (payable to National Propane Gas Association)  Check Number:
           Credit Card         American Express              MasterCard         Visa
          Credit Card Number:                                                       Expiration Date:
          Credit Card Holder:

          Signature:
                                  Signature authorizes National Propane Gas Association to charge the amount due.

                                      SUBMIT COMPLETED FORM TO NPGA BY APRIL 5, 2019
                                                   EMAIL: registration@npga.org

    13                                           Alabama Propane Gas Association  |  March / April 2019
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