PRE-REGISTRATION FORM
Renaissance Montgomery Hotel at the Convention Center and Embassy Suites (across the street)
AMEA In-Service Conference January
Home Address: (City) Email:
Primary Phone: School Name:
Principal Division:(check only one) ABA
AVA AVA ELEM
Other Division/s Affiliation:(check all that apply) ABA
ELEM
Please tell us if you are: Clinician
AOA AOA HED HED
Current Members, Clinicians, Conductors
Retired Members Registration Complimentary TOTAL AMOUNT PAID $
Conductor of a performing group at the conference First Year Teachers
Pre-Registration $85.00 (On-Site Registration $100.00)
Pre-registration $65.00 (On-Site Registration $75.00)
Spouse* or Guest* of AMEA Member
Registration $15.00 *may not be a music teacher
Name COLLEGIATE COLLEGIATE Retired Collegiate Members
Pre-Registration $30.00 (On-Site Registration $45.00)
Non-Member Alabama Music Teacher
Pre-Registration $185.00 (On-Site Registration $195.00)
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 8, 2015 Mail form and check by Jan. 7, 201 to:
AMEA, , , AL 35
Important: Forms and payment received after Jan. 7 will be held at the registration desk for onsite registration. Do not send forms or payment to the above address after Jan. 7, 201!
THANK YOU! Your conference packet will be ready at the registration desk in the Renaissance 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 # Membership verified and payment receipted by: ala breve
School Check # Date:
19 (State) (Zip)
LAST NAME _____________________________ FIRST NAME_____________________ (for badge)
NAfME ID#_______________________________ Please enclose a copy of your card.
New Address!
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