2012 Conference Registration

Please use this form to make a reservation. You will be able to pay online with your credit card or make a payment by mail. Our mailing address is: Ray Hittinger, NALIP Treasurer, P.O. Box 4416, Bethlehem, PA 18018-0416 Cancellation Policy: Cancellations before April 14 will be charged a $25 handling fee. Afterward, $75. 1.) COMPLETE THIS FORM --- Registration deadline is: May 17 Click here for additional information   Registration Fee Member, if received before February 28: $190 Non-Member, if received before February 28: $265 Member, if received between February 28 and April 14: $210 Non-Member, if received between February 28 and April 14: $285 Member, if received after April 14: $225 Non-Member, if received after April 14: $300 Member, if received after May 17: $325 Non-Member, if received after May 17: $325 n/a Non-clergy Spouse registration $120 CEU Processing Fee All participants who pay the full registration fee may apply for 10 contact hours (1 CEU) of continuing education. Application forms will be at the conference. Continuing Education Credit: $10 Annual Association Dues Pay annual association dues now and qualify for the member rate. IMA ELCA: $60 IMC - LCMS individual: $60 IMC - LCMS district: $250 n/a
Personal Information
First Name
Last Name
Address
City
State	AK AL AR AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VI VT WA WI WV WY
Zip
Work Phone
Home Phone
Email
Member of	ELCA    LCMS    n/a
Preferred Badge Name
Spouse's Name
Spouse's Preferred Badge Name
Cancellation Policy: Cancellations before April 14 will be charged a $25 handling fee. After April 14, cancellation fee is $75.