Spring Conference Member Registration

DIRECTIONS: The following online form may be used to by school related personnel to register for the NRCSA spring conference. Exhibitors DO NOT use this form!
To register please complete the form and press "Submit Form" at the bottom of the form. If your information is submitted successfully you will be taken to a confirmation screen that states: "Thank you, your information was sent successfully". If you are not taken to the thank you screen, or you are returned to form, this means the registration was NOT submitted.

NOTE: Fields marked by (*) are required.
School or Institution Name*
Address*
City, St, Zip*
Phone No* ( ) -
Contact Person*
Contact e-mail*
____________________________________________________________________________________________________
Number of Registrants*
Registrant # 1 Name*
Meals - Registrant # 1
Please indicate which meals the registrant will attend.

Registrant # 2 Name
Meals - Registrant # 2

Registrant # 3 Name
Meals - Registrant # 3

Registrant # 4 Name
Meals - Registrant # 4

Registrant # 5 Name
Meals - Registrant # 5

Registrant # 6 Name
Meals - Registrant # 6

Registrant # 7 Name
Meals - Registrant # 7

Registrant # 8 Name
Meals - Registrant # 8

Spouses or Guests
Please list the names of any guests attending. List one name per line.
____________________________________________________________________________________________________
Guest Meals - Thursday Lunch 3-22-12
Additional lunches for spouses or guests are available for a cost of $26 each. Please select the number of additional lunches to be ordered for guests. Please note that meal fees are included in conference fees for registrants.

Guest Meals - Thursday Dinner 3-22-12
Additional dinners for spouses or guests are available for a cost of $20 each. Please select the number of additional dinners to be ordered for guests. Please note that meals fees are included in conference fees for registrants.

Guest Meals - Friday Brunch 3-23-12
Additional brunches for spouses or guests are available for a cost of $18 each. Please select the number of additional brunches to be ordered for guests. Please note that meals fees are included in conference fees for registrants.
____________________________________________________________________________________________________

Conference Fees (Members)*
Conference fees for NRCSA member schools are $165 per person. Please select the fee based on the number of registrants attending.

Conference Fees (Non-Members)
Conference fees for Non-Members are $300 per person. Please select the fee based on the number of non-member registrants attending.

Total:*
Please add the amounts in the boxes above and enter the total here. This is the amount that is owed to NRCSA.
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.

If your information is submitted successfully you will be taken to a confirmation screen that states: "Thank you, your information was sent successfully". If you are not taken to the thank you screen, or you are returned to form, this means the registration was NOT submitted.
Confirmation Code:
Enter the code shown in the box before clicking on submit.

Note: Fields marked by an asterisk (*) are required.


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455 South 11th Street, Ste B Lincoln, NE 68508 Phone: 402-440-4378 Fax: 402-476-7740 email: jhabben@nrcsa.net
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