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2015 ANNUAL
CONFERENCE
AND EXPOSITION
●●Registration Fees (check box that applies)
If you plan on attending the Sunday, July 12 Awards Luncheon, an additional fee of $15 will apply,
so be sure to check the box next to the registration fee with the Luncheon added.
REGISTRATION FORM
Please type or print clearly all applicable information requested below.
Information following asterisks (*) will appear on your Conference badge.
Please make a copy for your records.
If you require hotel accommodations, please complete the Hotel
Reservation Form.
*Last Name ....................................................................................................................
*First Name ....................................................................................................................
*Title ................................................................................................................................
*Nick Name (ie: Buddy, Cindy, Joe, etc.) .................................................................
*County/Organization .................................................................................................
ADDRESS:
*City ................................................................................................................................
Early Bird Advance
(Fax/Mail)(Fax/Mail)On-Site
Postmarked by 5/29
5/30–7/9
Charlotte, NC
NACo Board of Directors
Luncheon Fee Added
NACo County Member
Luncheon Fee Added
State Association of Counties Staff
Luncheon Fee Added
NACo Corporate Member
Luncheon Fee Added
County Non-Member
Luncheon Fee Added
Corporate Non-Member
Luncheon Fee Added
Government
(Federal or State employees only)
Luncheon Fee Added
Spouse/Guest
Luncheon Fee Added
Youth
Luncheon Fee Added
Working Press (Editorial Staff ONLY) o $515 o $530 o $515
o $530 o $515
o $530 o $515
o $530 o $740
o $755
o $765
o $780
o $565
o $540
o $555
o $540
o $555
o $540
o $555
o $540
o $555
o $765
o $780
o $815
o $830
o $615
o $650
o $665
o $650
o $665
o $650
o $665
o $650
o $665
o $850
o $865
o $900
o $915
o $770
o $580
o $150
o $165
o $150
o $165
o Complimentary
o $630
o $170
o $185
o $170
o $185
o $785
o $180
o $195
o $180
o $195
$
Sub-total
*State ................................................................. Zip Code ..........................................
Phone ......................................................... Cell ............................................................
RECEIVE TEXT MESSAGE UPDATES DURING THE CONFERENCE
Fax ..................................................................................................................................
Email ...............................................................................................................................
o OPT OUT. Please check if you do not want your information shared.
●●Conference Tote Bag
Please indicate if you would like to receive a Conference Bag and one
will be ordered for you.
o Yes, I would like to receive one. o No thank you.
●●Additional Conference Celebration Event Tickets
(1 ticket is included with your registration fee). You may purchase additional tickets for the Conference
Celebration Event on Monday, July 13 for $50 each for non-registered guests.
# of Tickets: .................. @ $50 each.
Sub-Total for Extra tickets: $..................................
●●NEXTGEN Community Service Project
July 10, 2015 • 9:00 a.m. – 11:00 a.m.
# of Volunteers: ............ @ $25 each.
Sub-Total for Volunteer Project: $.........................
●●Advance Leadership Training: Creating Working Relationships that are Effective
July 12, 2015 • 8:30 a.m. – 12:00 p.m
o Yes, I would like to attend this session ($50)
Sub-Total for Training Session: $............................ ●●Dietary Restrictions
Please let us know if you have any of the following dietary needs:
●●NACo Technology Innovation Summit – Available for County Attendees ONLY
July 10, 2015 • 8:00 a.m. – 5:00 p.m.
(no additional fee required)
o Gluten Free
o Vegetarian
List any Allergies:
o Yes, I would like to attend this session at no-charge.
o Vegan
o Low Sodium
$
Total Registration and Ticket Fees .........................................................................................................................................
●●Special Services (check if applicable)
●●New to NACo?
(Please check any of the statements below that apply to you.)
o Yes, I will require special assistance.
Please let us know your requirements by attaching a separate sheet of paper outlining your needs.
o My county is a new NACo member.
o This is my first NACo Conference.
●●Payment Method (select one)
o I am a member of the ....................................................... affiliate.
o Check
●●Family/Guest Information (if applicable)
Spouse/Guest and Youth registration fees include admission to all General
Sessions, the Conference Celebration Event, the Exhibit Hall.
Card Number................................................................................................ Exp. Date .......................................
Spouse/Guest* Full Name
Signature .................................................................................................................................................................
.........................................................................................................................................
* If you are a County or Corporate employee, you may not register as a
guest or spouse.
Youth(s) Full Name
.........................................................................................................................................
Conference Tote Bag for Spouse/Guest
o Yes, they would like to receive one.
o No thank you.
Office Use Only
Date Received: ..................................................................Total: ................................
Check #: ..............................................................................Date Entered: ................
Amount of Check: .......................................................................................................
Entered by: ....................................................................................................................
o PO
o American Express
o Visa
o MasterCard
o Discover
Cardholder’s Name ..............................................................................................................................................
Your signature authorizes NACo to charge your credit card for the total amount due.
Payment Policy: Conference registration fee must accompany this form. Send check or company
purchase order, made payable to the National Association of Counties, to the Conference
Registration Center at the address listed below. A purchase order will only HOLD a registration. All
fees must be paid in full in order to obtain your badge and registration materials at the conference
Cancellation Policy: See NACo Website for more information.
Please return your completed conference registration form to:
NACo Conference Registration Center
PO Box 79007 / Baltimore, MD 21279-0007
Or fax your completed forms to: (866) 741-5129 • On-line Registration at: www.naco.org
Questions? Please call: (202) 942-4292 or email: [email protected]