NETRA Fall Conference Registration Form

Friday, November 14, 2008
The New England Center
Durham NH

Last name ________________________________________________________________

First name ________________________________________________________________

Name for badge (if different)
_________________________________________________

Organization
______________________________________________________________

Title _____________________________________________________________________

Preferred mailing address Home? 0 Work? 0

________________________________________________________________________

City,State, Zip
_____________________________________________________________

Phone _______________________________ Home? 0??Work? 0

E-mail address_____________________________________________________________

CTRS? Yes ___ No ___

Early registration is closed as of 11/1/08. All payments are now at the late/on-site rate of $135.00.

Conference registration fee with COUPON $120.00

Conference registration fee / On-Site Registration fee $135.00

Student registration fee $50.00

CEU fee $15.00

Total enclosed $____________

If you have a disability and may require accommodations in order to fully participate, please indicate here__________________________________________________________.

Would you like to be contacted to discuss your needs? ______

Personal checks, money orders, PayPal and purchase orders accepted.
Purchase orders must have numbers issued prior to conference. (Requests for purchase orders are not sufficient.) Checks should be made payable to NETRA. A $15.00 fee will be charged for any check that is returned from the bank.

All requests for refunds must be made in writing to NETRA. Cancellations before 11/1/08 will receive a full refund minus a $10 processing fee.
Cancellations before 11/10/08 will receive a 50% refund. Refunds will not be available for no shows.

Mail registration form and payment to NETRA, P.O. Box 79 , Concord NH 03302