Legislative Forum Registration

DIRECTIONS: The following online form may be used to by school related personnel to register for the NRCSA Legislative Forum.
To register please complete the form and press "Submit Form" at the bottom of the form.

NOTE: Fields marked by (*) are required.

School Dist / ESU Name*
District Address*
District City, St, Zip*
District Phone Number*	( ) -
Contact Person*
Contact e-mail*
______________________________________________________________________________________________________
Number of Registrants*
Registrant # 1 Name* First, M.I., Last
Registrant # 2 Name First, M.I., Last
Registrant # 3 Name First, M.I., Last
Registrant # 4 Name First, M.I., Last
Registrant # 5 Name First, M.I., Last
Registrant # 6 Name First, M.I., Last
Registrant # 7 Name First, M.I., Last
Registrant # 8 Name First, M.I., Last
______________________________________________________________________________________________________
Conference Fees (Members) Registration fees for members are $65.00 for the first person, $35.00 for each additional person.
Conference Fees (Non-Members) Registration fees non-member registration are $90.00 per person.
Total* Add the two boxes above. This is the total amount to be submitted to NRCSA

Schools will responsible for registrations canceled after February 19, 2012. STOP! Before you click "Submit Form", please print a copy of the completed form to give to your business office. This form generates an e-mail to NRCSA and can be used as an invoice. Additional invoices will be sent to the school if payment has not been received.

Confirmation Code: Enter the code shown in the box before clicking on submit.
	Note: Fields marked by an asterisk (*) are required.