Annual Conference Registration for Additional State Association Attendees

NGEDA Annual Conference Registration (additional state association attendees)

This form is designed for State Associations that have already renewed their annual membership and need to add registrants to the annual conference.

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This field is for validation purposes and should be left unchanged.

How will you be paying for your registration(s)?(Required)

Pay with credit card (preferred)

Pay with check

State Association

To be displayed on your badge.

Name(Required)

First Last

Title or Rank(Required)

Title or rank to be displayed on your badge.

Badge Name(Required)

How would you like your name to appear on your badge?

Cell / Home Phone(Required)

Business Phone

Email(Required)

Enter Email Confirm Email

The email address you are most likely to check regularly

How many individuals are you registering for?

Name of second registrant

First Last

Title or Rank (2nd Registrant)

Title or rank to be displayed on your badge.

Badge Name(Required)

How would you like your name to appear on your badge?

Name of third registrant

First Last

Title or Rank (3rd Registrant)

Title or rank to be displayed on your badge.

Badge Name(Required)

How would you like your name to appear on your badge?

Name of fourth registrant

First Last

Title or Rank (4th Registrant)

Title or rank to be displayed on your badge.

Badge Name(Required)

How would you like your name to appear on your badge?

Total

I HAVE CHOSEN TO PAY FOR MY REGISTRATION BY CHECK
I understand that my check must be received no less than 10 days prior to the event in order for my registration to be valid. If my check is NOT received in time, I will NOT be registered for the event.

I understand and agree(Required)

YES

You have said that you do not agree with the terms of payment by check for your registration. You may return to the top of the form and select to pay by credit card or you will need to contact the NGEDA office to register for this event.

Credit Card