CONVENTION REGISTRATION FORM
NACBA
th
ANNUAL CONVENTION 1992 2017
WALT DISNEY WORLD DOLPHIN HOTEL | MAY 4-7 , 2017 | ORLANDO , FLORIDA | # NACBA25
CONVENTION FEES
EARLY-BIRD MEMBER REGISTRATION ( received by Friday , March 17 , 2017 ) Early-Bird Member attendee and non-attorney staff of member firms
$ 695 / person $ _________
REGULAR MEMBER REGISTRATION ( received after Friday , March 17 , 2017 ) Regular Member attendee and non-attorney staff of member firms
$ 795 / person $ _________
EARLY-BIRD NON-MEMBER REGISTRATION ( received by Friday , March 17 , 2017 ) Early-Bird Non-Member attendee
$ 945 / person $ _________
REGULAR NON-MEMBER REGISTRATION ( received after Friday , March 17 , 2017 ) Regular Non-Member attendee
$ 1045 / person $ _________
LATE REGISTRATION ( received after Wednesday , May 3 , 2017 )
Late Member attendee $ 845 / person $ _________
Late Non-Member attendee $ 1095 / person $ _________
GUEST MEAL TICKET : #___ x $ 150 / ea . $ __________
CONVENTION REGISTRATION FORM
Copy and complete a separate form for EACH ATTENDEE .
Attendee Name of NACBA Member if attendee is a Non-Attorney Staff of an NACBA member firm ( REQUIRED )
Firm Name Address City / St / Zip
Phone
Attendee Email Bar # s and states for CLE credit : Most states will grant at least 15 hours of CLE credit
� ONE DAY SESSIONS
� Student Loans Workshop : ( Thursday , May 4 | 9:00 am - 4:00 pm )
� FDCPA Extreme ! ( Thursday , May 4 | 9:00 am - 4:00 pm ) Convention Attendee Rate $ 199 / person $ __________ Non-Convention Attendee Rate $ 299 / person $ __________
� SPECIAL DISCOUNTS
� Full-time , attorney-employees of non-profit college / university or non-profit legal service agencies : $ 200 discount $ __________
� TOTAL FEES DUE
� Check enclosed , payable to NACBA -or- � Charge my credit card as follows :
Name of Cardholder Credit Card Number Exp . Date Total charge to card $ Signature
Meal Tickets are NON-REFUNDABLE and should be purchased for Guests ONLY . Attendees do not need to purchase Meal Tickets ; meals are covered by tuition . Convention Cancelations received : On or before 5:00 pm EST Friday , April 7 , 2017 = 100 %. On or before 5:00 pm EST on Friday , April 21 , 2017 = 50 % + electronic materials . After April 21 , 2017 = Electronic materials only . All Convention Cancelations result in the forfeit of the free convention AudioPoint promotion .
Send your registration and payment :
• By mail to NACBA Admin , 5174 McGinnis Ferry Road , Suite 205 , Alpharetta , GA 30005
• By fax to 866.571.3560
• Online at nacbacon . org
HENRY J . SOMMER LEGAL AID SCHOLARSHIP
One scholarship is available to a legal aid attorney who attends the Convention and is a first-time attendee at an NACBA educational program . This scholarship has been created in recognition of the extraordinary contributions to NACBA by President Emeritus Henry J . Sommer , who served on NACBA ’ s Board from 1992 to 2011 and as President from 2005 to 2008 . The scholarship covers the registration fee and materials for the Convention . Interested candidates should submit by email a cover letter and resume to admin @ NACBA . com no later than Friday , March 17 , 2017 .