PRE-REGISTRATION FORM


AMEA In-Service Conference January 19-21, 2012


Renaissance Montgomery Hotel at the Convention Center, Montgomery, Alabama


LAST NAME ______________________________ FIRST NAME______________________(for badge)


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: ______________________________ Cell: ___________________________________ Primary Division Affiliation: (check only one) _____ABA


_____AVA _____AVA _____ELEM _____AOA _____ELEM _____AOA _____HED _____CMENC


Other Division/s Affiliation: (check all that apply, or none if only one division affiliation) _____ABA


_____Guest Performer _____HED _____CMENC


Please tell us if you are: _____Clinician _____Conductor of a performing group at the conference _____Retired


Current Members, Clinicians, Conductors


Pre-Registration $80.00 (On-Site Registration $90.00)


Retired Members Registration Complimentary First Year Teachers


Pre-registration $65.00 (On-Site Registration $75.00)


Spouse* or Guest* of AMEA Member


Registration $15.00 *may not be a music teacher


CMENC Members


Pre-Registration $30.00 (On-Site Registration $35.00)


Non-Member Alabama Music Teacher


Pre-Registration $185.00 (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, 2012


************************* Mail form and check by Jan. 10, 2012 to: *********************** AMEA, 1612 Second Avenue SW, #181, Cullman, AL 35055


Important: Forms and payment received after Jan. 10 will be held at the registration desk for onsite registration. Do not send forms or payment to the above address after Jan. 10, 2012!


THANK YOU! Your conference packet will be ready at the registration desk in the Renaissance Montgomery Hotel. Your receipt will be in your packet at the conference.


******************************************************************************************************************************************** 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: ____________________ ala breve 43


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