ASSE 2008 Annual Meeting
 Registration Form

The ASSE Annual Meeting Registration Fee includes the following benefits:

  • Welcome Cocktail Reception

  • Registration bag for ALL paid registrants

  • ASSE Awards Reception and Banquet

  • Admittance to the E. J. Zimmer Technical Seminar

Only those who pay the applicable ASSE Registration will receive these benefits.

REGISTRATION FEES
There will be a $25 fee for cancellations after November 1, 2008.

Member $300
Non-Member $375
Spouse/Companion $175
Non-Member Spouse/Companion $225
Children $50
E.J. Zimmer Tech Seminar Day Pass   $25

ANNUAL MEETING REGISTRATION

SPOUSE/COMPANION REGISTRATION
Last Name:

First Name:

Nickname (for badge):

Arrival Date:// 

Departure Date://

Membership #:

Company:

Address:

City/State/Zip:

Email Address:

Tel (Day):                                               1---

Tel (Evening):                                       1---

Fax:                                                         1---

Are you attending the Welcome Reception?
(You must be registered to attend)                          YesNo

Are you attending the Awards Reception?
(You must be registered to attend)                          YesNo

Is this your first ASSE Annual Meeting?     YesNo

Are you a Sustaining Member?                     YesNo

Are you a national committee chair?             YesNo

Are you a chapter president?                          YesNo

Are you a fellow of ASSE (FASSE)?             YesNo

Are you an International Past President?     YesNo

Last Name:

First Name:

Nickname (for badge):

Address:

City/State/Zip:

Tel (Day):                                               1---

Tel (Evening):                                       1---

Fax:                                                         1---

E-mail:

Are you attending the Welcome Reception?
(You must be registered to attend)                          YesNo

Are you attending the Spouse/Companion Brunch?
(You must be registered to attend)                          YesNo

Are you attending the Awards Reception?
(You must be registered to attend)                            YesNo

Is this your first ASSE Annual Meeting?                YesNo

CHILDREN'S REGISTRATION

Names & Ages

Are they attending the Awards Reception?            YesNo

METHOD OF PAYMENT

Check #
Visa  AMEX  MasterCard  Exp. Date /

*Credit Card #

**CVN #

*Name as imprinted on the card:

*Card Billing Address:

 

*Required fields for all credit card payments.

**Required. The Card Verification Number (CVN). On Visa and MasterCard, the CVN is a 3-digit number following the card number on the signature stripon the back . On AMEX cards, it is a 4-digit number on the front.

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