NEMA Annual Conference 99th Annual NEMA Conference | Page 25
REGISTRATION FORM
Each registrant must be listed on a separate form. Please make copies if
necessary and complete both sides of this form. Mail or email with your
payment by Septmeber 22, 2017 for the Early-Bird Rate or by October 6
for the Standard Rate to:
Save time with online registration!
nemanet.org/conference-register
NEMA 2017 Annual Conference
22 Mill Street, Suite 409
Arlington, MA 02476
[email protected]
Group rates are available!
See page 24.
Registrant Information
Print or type clearly. Your badge and the registration list will be printed with the information below.
First Name_______________________________ MI_________ Last Name________________________________________
Title________________________________________________________________________________________________
Institution_ __________________________________________________________________________________________
Mailing Address_______________________________________________________________________________________
City/State/Zip_ _______________________________________________________________________________________
Work Phone__________________________________ Twitter Handle (optional)_ ___________________________________
Check here if you would NOT like your phone number on the registration list.
E-mail_ _____________________________________________________________________________________________
Check here if you would NOT like your email address to appear on the registration list.
Membership Information Attendee Information
If registering at member rates, please check one: This is my first time attending a NEMA conference.
Individual Member
Institutional Member I'm willing to give a ride to a fellow registrant from
(Includes Institutional Affiliate Members)
Academic Affiliate Member
Business Member
New NEMA Member (Fill out information below.)
Cape and Islands Historical Association Member
my area.
I need a ride to conference.*
I am interested in sharing a room at conference. *
Join NEMA Now!
$50 Individual Member
Employees of museums and related non-profits.
$40 Reduced
Full-time Student (copy of ID required)
Job hunting (currently unemployed)
Volunteer or Retiree
For institutional and business membership, please visit
nemanet.org for membership information.
Note: Your contact information will be made
available to others who have expressed an interest
in sharing a room.
Wh ich nights would you need a roommate?
Tuesday
Wednesday
Thursday
I have special accessibility needs requiring
consideration.
(You will be contacted by NEMA staff.)
*NEMA does not guarantee that a room share or ride
share will be available.
If Registering as a Speaker:
Session title: ___________________________________
______________________________________________
I will only be attending my session. (No registration fee.)
(Please complete other side.)