N4A :: Regions :: Region II :: 2008 Region II Conference Registration Form

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“The Full Swing of Academics”
Myrtle Beach is the "golf capital of the United States.”

2008 Region II Fall Conference
October 26-28, 2008
Myrtle Beach, SC

REGISTRATION FORM

* Indicates Required Field

*First Name:

*Last Name:

*Professional Title:

*Institution:
2-Year 4-Year Other

If Other, Please Specify:

*Address Line 1:

Address Line 2:

*City:

*State (i.e. NC, SC, NY, etc):

*Zip:

*Phone Number:

*E-mail Address:

Fax Number:

*Are you a New N4A member? (Joined after last convention in June 2007)?

*What is your membership status?

*Do you need help finding a roommate?

Do your responsibilities include (please check all that apply)
Advising Revenue sports
Advising Non-Revenue sports
Tutoring
Life Skills
Director
Learning Specialist
Initial / Continuing Eligibility
Graduate Assistant
High School Counselor
High School Coach
High School Administrator
Other

CONFERENCE REGISTRATION FEES

How will you be paying the registration fees?*

If you chose the PAYPAL option, Please click on the appropriate link below to complete your payment in a separate window via PayPal. If you are paying with a check, please scroll down to the
"Check Payment Option".

NOTE FOR PAYPAL PAYMENTS: Your registration will NOT be fully processed by the N4A National Office until you submit the PayPal payment via the instructions at the bottom of this form AND SUBMIT this form online.

HOTEL/SHUTTLE INFORMATION:
Premier Resorts at Barefoot Resorts
2200 Premier Resorts Blvd.
Myrtle Beach, SC
Reservations: Call Hotel Phone Number: (800) 597-0154
Group Code Reference: 13C5YT

Rates WILL change after Sept. 11, 2008

For hotel shuttle contact Premier Shuttle Service at 843-237-9903 before October 19th, 2008, or email Maria premiermaria@yahoo.com

REGISTRATION INFORMATION:

Conference Fees

$85.00 (checks payable to N4A or read below for the quick and simple online option)

Registration Deadline:
Postmarked by Thursday, Sept 30, 2008
After September 30th, add $20 late fee to payment

*Send Registration & Payment to:
N4A National Office
Campus Box 8509
NC State University
Raleigh, NC 27695

Paypal Payment Option

CLICK HERE for the Payment Page
(You will be taken to a separate window to complete PayPal payment. Please disable all popup blockers if you do not see a separate page with PayPal button).

Additional Paypal Instructions

Once you have completed your payment from the PayPal website, please complete your registration by following these instructions:

1. Print 2 copies of this registration form. Either from this completed web form or from the submission e-mail which you will receive once you submit this form.

2. Print out your PayPal receipt. This can be obtained from either the receipt PayPal e-mailed you or from logging into your PayPal account.

3. Fax your PayPal receipt and a copy of this registration form to the N4A National Office at 919-513-0541. All registrations must be accompanied by FULL payment.

CHECK PAYMENT OPTION

Please make checks payable to N4A

N4A Federal Tax ID#: 33-0222728

-Print 2 copies of this registration form. Either from this completed web form or from the submission e-mail which you will receive once you succesfully submit this form.

-No Registration will be accepted until/unless it is accompanied by a check.

Send your check and 1 printed copy of your registration form(s) to the following address:

N4A National Office
Campus Box 8509
Raleigh, NC 27695-8509

PLEASE CLICK SUBMIT TO COMPLETE YOUR REGISTRATION.
YOUR REGISTRATION WILL NOT BE PROCESSED UNLESS YOU CLICK SUBMIT.
CLICK RESET TO RESET THIS FORM.

You should receive an e-mail with your registration information.
Please keep it for your records.
Also, you MUST print your copies of this form before clicking SUBMIT.

Thank you for registering for our 2008 Region II Conference!
We look forward to seeing you in Myrtle Beach