NJAD & NJRID Registration Form - nj

2015 NJAD & NJRID Biennial Conference
Hilton Hasbrouck Heights
650 Terrace Avenue, Hasbrouck Heights NJ 07604
NJAD & NJRID Registration Form
Please check which membership you are with:
NJAD
NJRID
Full name: _________________________________________________________________________
Add Guest/Spouse Full name:_______________________________________________________________
Address:__________________________________________________________________________________
City, State, Zip ______________________________________________________________________
Phone:______________________________________________________
VP
Voice
Fax
Email: _____________________________________________________________________________
CONFERENCE FEES:
1. Registration Fees Info: See the back of this page.
POSTMARKED & PAID
BEFORE/BY SEPT. 6
SEPT. 7 to NOV. 1
a. Pre-Conference Registration
NJAD/NJRID Member
NJAD/NJRID Non-member
b. Full Combo
NJAD/NJRID Member
NJAD/NJRID Non-member
$180. x ___
$200. x ___
$210. x ___
$230. x ___
c. Two Days Registration
NJAD/NJRID Member
NJAD/NJRID Non-member
$125. x ___
$145. x ___
$155. x ___
$175. x ___
Total: $ _________
Total: $_________
2. Payment of 2015-16 Membership Dues (membership form attached):
NJAD
Yes
No
NJRID
Yes
No
3. Special Dietary Meals:
Gluten Free:
You
Guest
Vegetarian:
You
Guest
Other: ___________
You
Guest
4. Special Request Accommodation:
Deaf-Blind
Low Vision
5. Plan to stay at the Hilton Hotel?
CART
Yes
Assistive
No
Reserved?
Yes
No
Cancellation/Changes/Refunds: All Registrations are non-refundable & non-transferable. No exceptions!
PAYMENT METHOD:
Check or Money Order payable to: NJAD-NJRID Conference. There will be a $35.00 fee charged on checks
returned by the bank due to insufficient funds. Registration confirmation/receipt will be e-mailed or mail.
MAIL TO:
NJAD & NJRID Registration, PO Box 250, Estell Manor, NJ 08319-0250
REGISTRATION INFORMATION:
Pre-Conference Registration includes the following: ????
Combo Registration includes the following: Friday Social night, Saturday admission to all the
workshops & exhibits; Morning/Afternoon Breaks, Awards Luncheon, Celebration Dinner, Entertainment
and Sunday Breakfast & workshop. NJAD and NJRID members save up to 60% on registration rates.
Two Days Registration includes the following: Friday Social night, Saturday admission to all the
workshops exhibits; Morning/Afternoon Breaks, Awards Luncheon, Celebration Dinner & Entertainment.