FOUR WAYS TO REGISTER ____ of ____ registrations from the same organization 1. ONLINE: ncdcconference.org/register | 2. FAX: 516.489.9287 | 3. MAIL: 86 Front St., Hempstead, NY 11550 | 4. PHONE: 888.TRY.NCDC (879.6232) INDIVIDUAL INFORMATION PREFIX FIRST NAME LAST NAME SUFFIX BADGE NAME TITLE ORGANIZATION ADDRESS CITY COUNTRY PHONE FAX STATE ZIP EMAIL WEB ADDITIONAL EVENTS REGISTRATION INFORMATION I plan on attending the Networking Breakfast on Wednesday, September 16: o YES o NO| Advanced Regular (until June 30) (after June 30) Registrants 1-3 o $645 o $695 Registrants 4-6 o $495 o $495 Seventh and succeeding o $435 o $435 Registrants 1-3 o $860 o $910 Fourth and succeeding o $610 o $610 Non-Member (nonprofit) o $745 o $795 Non-Member (corporate) o $1,400 o $1,400 Attendees Member Nonprofit NCDC Corporate Partners Pre-Conference Workshops Leadership Excellence with the Disney Institute Saturday, September 12 2 – 5 p.m. $50 Welcome Reception Sunday, September 13 6:00 – 8:30 p.m. $25 PAYMENT INFO Registration Fee $___________ Additional Fees o Add Pre-Conference Workshop [ ] $50 $__________ o Welcome Reception _____ ticket(s) @ $25 $__________ Total Fees $___________ o Enclosed is a check for $___________ o P lease charge the full payment to the following credit card: o AmEx o Discover o MasterCard o Visa CARD # EXP. DATE SECURITY CODE NAME OF CARDHOLDER SIGNATURE ADDRESS ON CARD (IF DIFFERENT THAN ABOVE) Cancellation policy All cancellations must be submitted in writing. Cancellations received on or before July 14 will receive a full refund minus a $150 administrative fee. Cancellations received after July 14 will not receive a refund. Spouse/Guest, Special Event, and workshop fees are non-refundable. Finance Assistance is available through the Archbishop Murphy Scholarship Fund. To learn more and/or apply, please visit www.ncdcconference.org/scholarship ncdcconference.org/register