NAPSEC Legislative Day

Washington, DC

May 5, 2011

We encourage you to bring parents and students to meet with Congressional Representatives. The first parent/student registration is free, the second registration is $75.00.
 Name
 Name of Program
Street Address
City/State/Zip
Phone
Email

Send Confirmation Email to this address
 Luncheon  Put an X in the box if not attending
Please indicate food Allergies, Vegetarian
Hill Visit Requests

Type names of Congressional Members

Please list in order

of priority
You can schedule my appointments during lunch if needed Yes    No

Parent Registration

Name

Parent Registration

Name

Parent Registration

Name

Student Registration

Name

Student Registration

Name

Student Registration

Name

Number of Parents/Students Attending Luncheon

Please Indicate Food Allergies, Vegetarian

 SPONSORSHIP

  Breakfast   Luncheon

 Reception  Parent/Student Registration

 Amount Paid - Thank you! 

Member Registration $250

 Amount Paid

Non Member Registration

$350

 Amount Paid

2nd Parent/Student Registration

$75.00

 Amount Paid
Total Paid Total Amount Paid
Pay By Check

 Please check here if paying by check

 

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

Total Paid by

Credit Card
THANK YOU!

Thank you for registering for the NAPSEC Legislative Day!

See you in Washington!

Please make a copy

of your registration

for your files.

NAPSEC Home Page