2012 NAPSEC Annual Leadership Conference
January 15-18, 2012
Name
as you want it to appear on your
name badge
Agency
Street Address
City/State/Zip
Phone
Emergency contact
while at conference
Phone:
Cell Phone
For on-site use
Fax
Email
Send Confirmation Email to:
First time/second time attendees please check
Would you like a mentor during the conference?
First time I have attended conference
Second time I have attended conference
Yes, I would like a mentor for the conference
Please Indicate Food Allergies/or if
Vegetarian
Not Attending Awards Luncheon
put an X in the box if not attending Awards Luncheon
REGISTRATION FEES
Payment must be received before November 18th to qualify for the lower rate.
Member Registration BEFORE November 18, 2011
Member Registration AFTER November 18, 2011
Non Member Registration BEFORE November 18, 2011
Non Member Registration AFTER November 18, 2011
FOR LOCAL PHOENIX AREA PROGRAMS
Day Rate
This option was added to accommodate schedules for
local programs allowing them to select to attend one or two
days during the conference. Programs wishing to attend
three days, must pay the full conference rate.
Link to Schedule
Monday
Tuesday
Wednesday
OPTIONAL EVENTS
NCASES
How to Prepare For NCASES Accreditation
Name(s)
$65
$ Total for NCASES
NCASES Site Reviewer Training
List attendees
No Charge for attendance
NCASES Team Leader Training
Golf Tournament
Tuesday, January 17th
Golfer(s) Handicap/average shot/18 holes
List handicap in same order as names above
Check If Renting Clubs for each golfer registered
Golfer 1 will rent clubs at The Camelback Golf Club
Golfer 2 will rent clubs at The Camelback Golf Club
Golfer 3 will rent clubs at The Camelback Golf Club
$140 Per Golfer
$ Total Paid for Golf
GUEST REGISTRATION FEES
Please check appropriate selections for your guests
Full guest fee includes all meals & events
In addition to the below events, the full guest fee includes
breakfasts, breaks & attending the conference
Guest Name
Full Guest Fee $250
Welcome Reception $45
Wine Tasting Reception $45
Western Welcome Reception $45
Awards Luncheon $55
Total Number of Guests Attending Awards Luncheon
put an X in the box if NOT attending Awards Luncheon
Total for Guests
$
Total for Registration
Total for Optional Events
PAYMENT
Check
Total Paid
Mail Payment To:
NAPSEC
601 Pennsylvania Avenue, NW, Suite 900 - South Building
Washington, DC 20004
Credit Card Payment
Visa MasterCard American Express
Credit Card Number
Expiration Date
Name on Card
You are not officially registered until payment is received.
Cancelations received before December 28, 2011 will be refunded in full minus a $50 handling fee. No refunds will be given after December 28, 2011.
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