N4A :: Regions :: Region IV :: 2009 Region IV Conference Registration Form

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2009 Region IV Fall Conference
February 15-17, 2009
Dallas, TX
Hosted by: Texas Christian University (TCU)

REGISTRATION FORM

* Indicates Required Field

*First Name:

*Last Name:

*Professional Title:

*Institution:
2-Year 4-Year Other

If Other, Please Specify:

*NCAA Conference:

*Address Line 1:

Address Line 2:

*City:

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

*Zip:

*Phone Number:

*E-mail Address:

*Are you a New N4A member? (Joined after last convention in June 2008)?

*What is your membership status?

*Will you be attending the N4A Welcome Reception on Monday, February 16, 2009?

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:
Hyatt Regency Dallas
300 Reunion Blvd
Dallas, TX 75207
(214) 651-1234
www.dallasregency.hyatt.com
$120 /night + tax

**Reservations must be made by January 14, 2009 to guarantee rate and availability.

Pricing
Call the hotel and let them know you are with N4A Region IV conference to receive group pricing.

REGISTRATION INFORMATION:

Conference Fees

$60.00 for current members of N4A if paid online or postmarked by January 14th

$70.00 for guests (non-members of N4A) if paid online or postmarked by January 14th

Note: $20.00 late fee will be added if paid online or postmarked after January 14th

Make checks payable to N4A or read below for the quick and simple online option

*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:

Attn: Region IV Conference Registration
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.

Please direct all questions and inquiries to:

Ragean Hill
Kansas State University
Phone: (785) 532-5193
Fax: (785) 532-5191
Email: rrh7364@ksu.edu

Thank you for registering for our 2009 Region IV Conference!
We look forward to seeing you in Dallas, TX!