PRE-REGISTRATION FORM
LAST NAME ______________________________
AMEA In-Service Conference
FIRST NAME______________________(for badge)
January 21-23, 2010
University of Alabama, Tuscaloosa, Alabama
MENC ID#_________________________________
Please enclose a copy of your card.
Home Address: __________________________________ ____________________ ______ _______
(City) (State) (Zip)
Home Phone: ______________________________ Email: __________________________________
School Name: ______________________________________________________________________
School Address: _________________________________ ____________________ ______ _______
(City) (State) (Zip)
School Phone: ______________________________ Fax: ___________________________________
Division Affiliation: (check all that apply)
_____ABA _____AVA _____ELEM _____AOA _____HED _____CMENC
Please tell us if you are: _____Clinician _____Conductor of a performing group at the conference
_____Retired _____Guest Performer
Current Members, Clinicians, First Year Teachers CMENC Members
Conductors
Pre-Registration $80.00 Pre-registration $65.00
Pre-Registration $20.00
(On-Site Registration $90.00) (On-Site Registration $75.00)
(On-Site Registration $25.00)
Retired Members Spouse* or Guest* of
Non-Member Alabama
AMEA Member
Music Teacher
Registration Complimentary
Registration $15.00
Pre-Registration $185.00
*may not be a music teacher
(On-Site Registration $195.00)
TOTAL AMOUNT PAID $____________ MAKE CHECKS PAYABLE TO AMEA
A fee of $35 will be charged for returned checks
No Purchase Orders Accepted. Check or Credit Card Only
To pre-register with a credit card go to www.alabamamea.org through January 10, 2010
************************* Mail form and check by Jan. 10, 2010 to: ***********************
AMEA, 1612 Second Avenue SW, #181, Cullman, AL 35055
Important: Forms and payment received after Jan. 10, 2010 will be held at the registration desk for onsite registration.
Do not send forms or payment to the above address after Jan. 10, 2010!
THANK YOU! Your conference packet will be ready at the registration desk in the Bryant Conference Center.
Your receipt will be in your packet at the conference. Please contact me if you need further assistance.
Mary Jo Lakin, Interim Treasurer and Registrar Email: mlakin@alabamamea.org
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Please do not fill in the information below. This is for AMEA bookkeeping ONLY
Personal Check # _________________________ School Check # ______________________
Membership verified and payment receipted by: ________________________________ Date: ____________________
24 August 2009
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