2013 Annual Conference and Member Meeting – mail-in registration form

June 8, 2013

Lido Beach Resort, Sarasota, FL
 
 
TO REGISTER BY MAIL, PLEASE COMPLETE THIS FORM AND SEND IT WITH YOUR CHECK OR 
CREDIT CARD INFORMATION TO USNC-UN Women, 1120 20th St. NW, #500 North, Washington, DC  20036
 
First name: *
Last name: *
Email: *
Address Line 1: *
Address Line 2:
City: *
State: *
ZIP/Postal Code: *
Country (if not US): *
Telephone:*
 
Type of Registration (please select one):

__  $60.00    Conference only – USNC-UN Women Member
__  $100.00  Conference & Reception – USNC-UN Women Member
__  $75.00    Conference only – Non-Member*
__  $115.00  Conference & Reception – Non-Member*
__  $15.00    Conference only – Student
__  $55.00    Conference & Reception – Student
__  $600.00  Conference & Luncheon Sponsor Table for 10
 
*Become a USNC-UN Women member through the day of the conference and take advantage of the member registration rate today!  www.unwomen-usnc.org/join

Payment Method:

__  Check payable to USNC-UN Women is enclosed
__  Charge my credit card
 
Cardholder Name:*     
Billing Address (if different than above):*          




Telephone Number:*
Card Type:*                   
Card Number:*             
Security Code: *           
Expiration Date:*           
 


If you have questions, please email   or call 202-469-8732.