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PRE-REGISTRATION FORM


AMEA In-Service Conference January 21-23, 2016


Renaissance Montgomery Hotel at the Convention Center and Embassy Suites (across the street)


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, 2016 to:


AMEA Registration, PO Box 3385, Muscle Shoals, AL 35661


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, 2016!


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:


55 (State) (Zip)


LAST NAME _____________________________ FIRST NAME_____________________ (for badge)


NAfME ID#_______________________________ Please enclose a copy of your card.


New Address!


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