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.