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20TH ANNUAL NSPAA TECHNICAL ASSISTANCE WORKSHOP SERIES
June 2-5, 2015
Sheraton Pentagon City Hotel – Arlington, Virginia
2015 Registration Form
(One form per individual)
All Early Registrations must be postmarked by April 24, 2015. To qualify for group discounts, individual registration forms
must be clipped (submitted) together in the same package for all individuals in the group, with no more than one payment
covering all persons in the group. Registration forms will also be posted online at www.NSPAA.com
Annual Membership Fee
Only
$350 per person (For those not attending the
Technical Assistance and Advancement Series)
$ 500 per person
$ 900 for groups of two per institution
Early Bird
Rates
$1,800 for groups of four per institution
Standard
Rate
$1,000 for groups of two per institution
$2,000 for groups of four per institution
Postmarked on or before
April 24, 2015
$600 per person
Non Member Rate
*Onsite
Paid by June 5, 2015
Postmarked between
April 24, 2015 – May 23, 2015
$450.00
Postmarked before May 23, 2015
*Onsite Rate
June 2 – June 5, 2015
$650 per person
Forregistrationinformation,pleasecontact:
ElbertMalone,NSPAAPresident(803)536‐[email protected](803)536‐[email protected]
Check One:
Check One:
Check One:
 Individual
 Group of 2
 Group of 4
 Early Bird
 Standard
 Onsite ** (Do not mail after May 23, 2015)
Group Registration Fee applied to this form  NSPAA PROGRAM PARTICIPANT
 1 of Group 2
 2 of Group 2 or  1 of Group 4
Name:
 2 of Group 4
 3 of Group 4
 4 of Group 4
Title:
Organization:
Email:
Address:
City/State/Zip:
Phone:
Fax:
TOTAL PAYMENT AMOUNT: Individual:
Group: 2 or  4
Method of Payment (NSPAA HBCU, Inc. EIN: 59-3219364)
Make payable to National Sponsored Programs Administrators Alliance of HBCU, Inc.
Check
 Money Order **Purchase Order
 Credit Card: 
Cardholder's Name:
Visa or  Master Card
**To complete
registration, a Purchase
Order must be attached
to this form or faxed later
if only a PO number is
given.
Exp. Date
Cardholder's Signature : ___________________________
SEND REGISTRATION FORM(S) AND PAYMENT(S) TO:
Mr. Waverly L. McMichael Jr., NSPAA Board of Directors
Office of Sponsored Programs, Morehouse School of Medicine, 720 Westview Drive SW, Atlanta, Georgia 30310-1458
Phone: (404)752-1615
Fax: (404)756-6664
Email: [email protected]
*Important: Starting June 1, 2015, onsite rates will apply. Do not mail forms and payments, but do fax the registration form to: 404-7566664, then submit forms and payments onsite at the Conference registration desk. Notifications of cancellation must be submitted in
writing. Cancellations received by April 17, 2015 will be subject to a $75 cancellation charge. No refunds will be given after May 15 , 2015.
.