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Conference Registration

May 16-18, 2012
Courtyard Marriott, Carolina Beach, NC


	Name
	Company/Agency
	Address
	City
	State
	Zip
	Phone
	Fax
	Email
	I require the following special accommodations in order for me to fully participate (sign interpretation, assistive listening device, materials in alternate format, dietary needs, or other).


	NCGA MEMBERSHIP FEE (Join now and save)


	PRE-CONFERENCE REGISTRATION FEE
	per person (Fee includes all handouts) - 25.00

	CONFERENCE REGISTRATION FEES (After 04/27/2011 a $25 late fee will be added)
	(Fee includes: Lunches (lunch on Wednesday if pre-ordered, Thursday), Two Continental Breakfasts and Handouts)
	Non-Member - 300.00
	Thursday Only - 135.00
	Wednesday or Friday Only - 80.00
	Please check this box if you wish to have lunch available on Wednesday.

	ADDITIONAL MEAL TICKETS FOR SPOUSE/GUESTS
	Lunch (Wednesday, May 16) - 12.00 How many?
	Luncheon (Thursday, May 17) - 20.00 How many?

	NCGA GUARDIANSHIP EXAM
	Will not attend the Conference - 100.00
	Will attend the Conference - 50.00
	NCGA Guardianship Manual - 75.00 How many?


To help in our planning, please indicate the letter (A, B, C, etc.) of the sessions you plan to attend.
Thursday: 9:00 AM 11:00 AM 2:15 PM


*Refund Policy: No refunds will be issued after April 30, 2010. A refund minus a $15 administrative fee will be awarded for cancellation before April 30, 2010. Someone may substitute for you at the conference. Please make checks payable to NCGA, P. O. Box 17673, Raleigh, NC 27619. Contact Brenda Spaanbroek at 919/266-9204 or email ncguardian@aol.com for more information.