4. NACO annual conference - Laserfiche WebLink

CONFERENCE REGISTRATION FORM July 16 - 20, 2004 · Phoenix Civic Plaza ~ Maricopa County ~.: Phoenix, Arizona HOTEL RESERVATIONS [] Please check this box if you will NOT require hotel accommodations. If you DO require housing, please complete the hotel form on the back of this form. Please type or print dearly all applicable information requested below. Information following asterisks (*) will appear on your Conference badge, Please make a copy of this form for your records. *Last Name *First Name *Nick Name *Title *County/Organization Address City *State Zip Code Telephone (__) Fax ( ) Email Please provide your email address to receive a quick confirmationl [1~[] OPT OUT Please check here if you do not want your information shared with 2004 Conference Exhibitors. [] Check here if you are a NACo Board Member. SPECIAL SERVICES [] Please check here if you require any special assistance. If you do require any special assistance, please attach a separate sheet of paper outlining your needs. SPOUSE INFORMATION Last Name First Name YOUTH INFORMATION Last Name First Name Spouse and Youth registration fees include admission to all General Sessions, the Conference-Wide Event, the Exhibit Hall Lunches, and the Inaugural Gala. REGISTRATION FEES EARLYBIRD ADVANCE ON-SITE Check box that applies postmarked by 5/~ ........... Received between 5/7 and 7/15 in Phoenix NACo County Member [] $390 [] $440 [] $590 State Association of Counties Staff [] $390 ...... [] $440 [] $590 NACo Corporate Member [] $390 .......... [] $440 .............. ~ 5~L~ Non-member County - r~ $490 [] $540 [] $690 Government ..................................... ~-~deral or State Employees One) [] $440 ~ $~ ............... [] $640 Private Sector [] $515 __._ [] $565 [] $715 S~.ouse [] $100 __ []$115 1~$165 Youth [] $100 [] $115 [] $165 Working. Press Complimentary NEWI You may purchase single tickets for the Conference-Wide Event for $50 each, II of Tickets: __ @ $50 each. Total Cost: SUB-TOTAL DUE: $ iADVANCED LEADERSHIP TRAINING (ALT) Get on early start wh'h NACo's Advanced Leadership Training (ALT) Pre-Conference Seminars! Your leadership is our business~ Our half-day and furl-day pre-conference seminars focus on essential leadership concepts and skills that help you gui~Je your county tJnrough these difficult times. Please circle the appropriate Seminar rate you wish to attend. ALT Pre-Conference Seminar # 1: Communication and Outreach Strategies for Your Various Publics Friday, July 16, 8:30 a.m. - 3:30 p.m. (full day) Individual $150 $150 Team (3 or more) $140 $140 ALT Pre-Conference Seminar # 2: Managing for Results: Making Government Work for Your Customers and Citizens Saturday, July 17, 8:30 a.m. - 3:30 p.m. (full day) Individual [] $150 $150 Team (3 or more) [] $140 $140 ALT Pre-Conference Seminar # 3: Applying Leadership Lessons from Hercules to Defeat Today's Monstrous Challenges Saturday, July 17, 8:30 a.m.- 11:45 a.m. (half day) individual [] $ 75 $ 75 Team (3 or more) [] $ 65 $ 65 ALT Pm-Conference Seminar #4: Decision-Making Models for Leading and Directing Change Saturday July 17, 1:00 p.m.- 4:00 p.m. (haffday) Individual [] $ 75 $ 75 Team (3 or more) [] $ 65 $ 65 ALT Pm-Conference Seminar #5: Governing and Campaigning in the Age of Television, Internet, and E-Mail Saturday July 17, 1:00 p,m. - 4:00 p.m. (half day) Individual [] $ 75 [] $ 75 Team (3 or more) [] $ 65 [] $ 65 SUB-TOTAL DUE: $ I TOTAL AMOUNT DUE ¢~r~,~c~-~eE~r~,~r~'am~e.' $ L HELP US KNOW MORE ABOUT YOU Please take a moment and complete the following information to help us serve you better! ARE YOU NEW TO NACo? (Please check any of the statements below that apply to you.) [] My county is a new NACo member [] This is my first NACo Conference [] I am a newly elected county official [] I am a member of the affiliate. WHAT ROLE DO YOU PLAY IN THE PURCHASE OF PRODUCTS AND SERVICES WITHIN YOUR COUNTY? [] Final Say ~ Specifly Supplier [] Recommend [] No Role WHAT IS YOUR COUNTY'S TOTAL PROCUREMENT BUDGET? [] $10,000 or less [] $10,000- $50,000 [] $50,000- $100,000 ~ $100,000- $500,000 [] $500,000-$1 million [] $1 million plus PLEASE RETURN YOUR COMPLETED CONFERENCE REGISTRATION FORM 1'O: NACo Conference Registration Center PO Box 12862 Philadelphia, PA 19101-0862 Or fax your completed form to: (610) 328-1548 Questions? Please call: (866) 844-2207 On-line Registration Available at: VWNw. naco.org PAYMENT Conference Registration fee MUST accompany this form. Send check, voucher or company purchase order, MADE PAYABLE TO THE NATIONAL ASSOCIATION OF COUNTIES. A purchase order will only hold your registration. All fees must be paid In order to obtain your badge and tickets at the Conference, Please select one: ~] Check [] VISA [] MasterCard [] AMEX [] Discover [] Purchase Order/Voucher Card Number: Exp. Date: Signature: [Your ,dgnatore author~es NACo to charge your credit card for the total amount due) OFFICE USE ONLY DATE REC'D: TOTAL: CHECK #: DATE ENTERED: AMOUNT OF CHECK: ENTERED BY'