Individual Member/Spouse/Guest/Nonmember Conference Registration
Application
______ Member ______ Spouse
______ Guest ______ Nonmember
Individual members should use this form
to register. Supporting members must complete the form in their
conference packet.
List name and affiliation as they should
appear on your badge:
__________________________________________
Name
__________________________________________
Affiliation
__________________________________________
Membership Type
__________________________________________
Address
__________________________________________
City/State/Zip
__________________________________________
Spouse’s Name (if registering for conference)
__________________________________________
Guest of (if registering as guest)
E-mail
____________________________________
Arrival Date: ________ Departure Date:
_______
_____ Check if this is your first
conference
_____ Check if you want a mentor for your
first conference
Do you have any special needs?
___________________________________________________
Is your spouse interested in a spouse trip? yes ___ no ___
Name _________________ Contact
_____________________
Contact names and numbers in case of
emergency:
___________________________________________________
___________________________________________________
___________________________________________________
NOTE: Spouses must be registered and pay
fees to participate in conference activities. Active members may
register their spouse and a guest(s) for conference, provided guests are
aged 18 or older. Nonmembers with an interest in joining OWAA may attend
conference, with headquarters’ approval. Nonmembers pay a surcharge
equal to active member annual dues and membership application fee
(included in full registration fee). The surcharge may be applied toward
membership if the registrant joins OWAA by Aug. 18, 2006.
Registration Fees
Member, spouse or guest of member
Until May 3: Full registration: $190
Single day rates: $50 per day
After May 3: Full registration: $225
Single day rates: $60 per day
After May 24: Full registration: $250
Single day rates: $65 per day
Nonmember (must have prior approval)
Until May 3: Full registration: $390
Single day rates: $100 per day
After May 3: Full registration: $425
Single day rates: $110 per day
After May 24: Full registration: $450
Single day rates: $115 per day
The registration fee is fully refundable
if cancellation is received on or before May 3. After May 3, $140 will
be refunded on individual member registrations, $290 on nonmember
registrations. No-shows will not receive refunds.
Make checks payable to OWAA; write
“registration fee” on check OR charge to
___ VISA ___ MasterCard ___ AmEx ___ Disc
Signature
__________________________________
Card No.
__________________________________
Exp.
Date__________________________________
_____ Yes, I’d like to take advantage of
pre-conference prices and buy 100 raffle tickets for $165 (enclosed).
(Need not be present to win. No refunds.)
Total registration fees $ ____________
Raffle ticket subtotal $ ____________
Add $2 if paying by credit card $
____________
Total enclosed: $ ____________
Conference registrations may be made by
mail. Faxed registrations accepted if paying by credit card. No phone
registrations are accepted.
Return form to:
OWAA
Attn: Terri Roberts
121 Hickory St., Ste. 1
Missoula, MT 59801
406-728-7445 fax
troberts@owaa.org |
