PRE-REGISTRATION FORM AMEA In-Service Conference


January 18-20, 2007 University of Alabama, Tuscaloosa, Alabama


Home Address: _______________________ Home Phone: __________________


School Name: _________________ School Address: _________


School Phone:_________


LAST NAME__________________________ FIRST NAME__________________


____ (for badge) MENC ID#_____________


___ ________________ (City)


Email: __________________ __________________________


________________ _______ (City)


__________________ FAX: _______________


Please enclose a copy of your card. ____ ___ _________ _______________


(State) (Zip Code)


__________ ___ ___________ (State)


(Zip Code) _______________________


Division Affiliation: (check all that apply) ___ABA ___AVA ___ELEM ___AOA ___HED ___CMENC


Please tell us if you are: __Clinician __C


Current Members, Clinicians, Conductors Fi Pre-Registration $70.00


Retired Members: Registration Complimentary TOTAL AMOUNT PAID $__________ onductor of a performing group at the Conference


__Retired __Guest Performer rst Year Teachers:


 Registration $15.00 - *may not be a music teacher


CMENC Members:


 Pre-Registration $55.00  Pre-Registration $20.00 Spouse* or Guest* of AMEA Member:


Name for Badge _________________


___ MAKE CHECKS PAYABLE TO AMEA. A fee of $25.00 will be charged for returned checks.


PLEASE READ – NO PURCHASE ORDERS WI YEAR. YOU MUST PAY BY CHECK OR CREDIT


PRE-REGISTRATION. To Pre-register with a credit card online to


LL BE ACCEPTED FOR REGISTRATION THIS CARD FOR BOTH ONSITE REGISTRATION AND


www.alabamamea.org


*************Mail form and check by Ja AMEA, Box 181, 1612


IMPORTANT


THANK YOU! Your conference packet wi Your receipt will be in your p


******************************


Personal Check #_________________ Membership verified and payment r


ala breve through January 1, 2007. n. 1, 2007 to:************* Second Avenue SW, Cullman, AL 35055


- Forms and payment received after Jan. 1, 2006 w registration. Do not send forms or paymen


Cindy Pass, Treasurer, AMEA and Registrar ****************************


ill be held at the registration desk for onsite t to the above address after Jan. 1, 2006. ll be ready at the registration d Please do not fill in the information be


acket at the conference. Please contact ****************************


eceipted by: _____________


esk in the Bryant Conference Center. me if you need further assistance.


Phone: (256)338-4404 Email: cpass@cullmancats.net **********************


******************* low. This is for AMEA bookkeeping ONLY. School Check #___________________ ______________ Date: ____________ 15 **********


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