Registration form two pages name: New Member?



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növüRegistration form

AFTA 2017

ANNUAL MEETING and OPEN CONFERENCE

May 31 - June 3, 2017

REGISTRATION FORM - TWO PAGES

NAME: New Member?

(as you want it to appear on your name badge-print clearly please!)

ADDRESS:

DAY PHONE: EMAIL:

FEES: (U.S. Funds Only)

1. Registration:

After

Early 5/8

AFTA Member $445 $495

AFTA Early Career Member $375 $395

AFTA Student Member $350 $375

Non-Member $545 $560

Non-Member Student $350 $375

Student Scholarship $150 $175

One-Day Registration (specify day): $195 $195

Spouse/Partner (Plenaries only) $230

Name of Partner: $

2. Welcome Reception, Wednesday, May 31 No Fee w/ full registration Yes/No

3. New Members Breakfast, Thursday, June 1 No Fee w/ full registration Yes/No



4. Special Events on Thursday, June 1 - Pre-Registration Required

Special Event I: Mural Tour $40 $

Box Lunch w/ tour? $20 $

Special Event II: Dinner and Talent Show $50 $

5. Student / Early Career Lunch, Friday, June 2 No Fee w/ full registration Yes/No

6. Saturday Box Lunch at Town Hall Meeting, Saturday, June 3 $20 $

7. Awards Ceremony & Dinner, Saturday, June 3 No Fee w/ full registration Yes/No

Extra Guest Tickets $90 x $
Fundraiser for AFTA

AFTA Mug $10 $


AFTA Philadelphia T-Shirt Size? ___ S ___ M ___ L ___ XL $25 $
TOTAL AMOUNT ENCLOSED/TO BE CHARGED: $

PAYMENT METHOD: (U.S. Funds Only)

BY CHECK CANCELLATION DEADLINE

BY CREDIT CARD: (Visa/MasterCard ONLY) $50 processing fee for cancellations before May 8, 2017, and 50% refund ONLY after May 8, 2017

Card # Exp. Date: CVV:

Your Signature:



AFTA, 150 Summer St., Haverhill, MA 01830; Fax: (978) 914-7033; Phone: (978) 914-6374
Any dietary restrictions?

Any other special needs?




SESSION REGISTRATION - Required for registration completion

Refer to AFTA Program for Session Details, Select one for each blank
Wednesday, May 31:

1. Network Conversations I, 11:00 AM-12:30 PM:

People of Color OR Conversation on White Privilege
2. LGBTQI Network Conversations II, 1:00-2:30 PM:
3. Member Dialogue, 3:00-6:00 PM
4. Round Table Conversations, 7:30 - 9:30 PM
Thursday, June 1:

5. CS-101 - CS-103, IG-101 - IG-110, 10:45 AM-12:15 PM


6. Dialogue for All, 3:00-6:00 PM
Friday, June 2:

7. CS-201 - CS-213, 10:45 AM-12:15 PM


8. Institutes, 7:30-9:30 PM, Women or Men:
Saturday, June 3:

9. CS-301 - CS-310, 10:45 AM-12:15 PM


10. Town Hall Meeting, 12:30-1:30 PM
11. CS-401 - CS-409, IG-111, 2:00-3:30 PM




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