PRE-REGISTRATION FORM


AMEA In-Service Conference January 19-21, 2006 University of Alabama, Tuscaloosa, Alabama


LAST NAME _____________________________ FIRST NAME_____________________________


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 First Year Teachers


Current Members, Clinicians, Conductors


Pre-Registration $70.00 Retired Members Registration Complimentary


Spouse* or Guest* of AMEA Member Registration $15.00


Name for Badge: ____________________________________ *may not be a music teacher


TOTAL AMOUNT PAID $____________ MAKE CHECKS PAYABLE TO AMEA A fee of $25 will be charged for returned checks


PLEASE READ


Mailed Pre-registration can only be paid by check. No P.O.s accepted by mail. To pre-register with a credit card or P.O. go online at www.alabamamea.org through December 1, 2005.


**********************Mail form and check by Jan. 1, 2006 to our new address:******************** AMEA, Box 181, 1612 Second Avenue SW, Cullman, AL 35055


Important: Forms and payment postmarked after Jan. 1, 2006 will be held at the registration desk for onsite registration. Do not send forms or payment to the above address after Jan. 1, 2006


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. Cindy Pass, Treasurer, AMEA and Registrar Phone: (256) 338-4404 email: cpass@cullmancats.net


**************************************************************************************************************************************** Personal Check # _________________________


Please do not fill in the information below. This is for AMEA bookkeeping ONLY School Check # ______________________


Membership verified and payment receipted by: ________________________________ Date: ____________________ 14 ala breve - October 2005 CMENC Members Pre-registration $55.00 Pre-Registration $20.00


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