NAACP

NAACP

Alaska Oregon Washington State-Area Conference

2017 Fall Convention Online Registration Form

Online Registration Form

Alaska, Oregon, Washington State Conference of the NAACP
FALL CONFERENCE
October 6th - 8th, 2017
Embassy Suites by Hilton Seattle North Lynnwood
20610 44th Ave West, Lynnwood, WA 98036


PRINTABLE FORM - Convention Registration Form
(Mail with Check or Money Order) to: Attn: D.Patton-Treasurer - AOWSAC, 2115 Tidepool Pl E - Port Orchard WA 98366

SECTION 1 - CONTACT INFORMATION (for individual filling out this form)
(Please provide the name and contact information of the delegate(s) for advance registration)
IMPORTANT - THIS PERSON MUST ALSO BE LISTED AS A PAID DELEGATE ON THIS FORM

Fields marked with * are required.

First Name
*
Middle Name
Last Name
Street Address
Address Line 2
City
State
Zip Code
Email Address
*
Phone Number
*
Phone Type
FAX Number
Unit Name
Unit Number


SECTION 2 - BRANCH/UNIT MEMBER REGISTRATION PACKAGE AND TICKET ORDERS
Please review your package selection below
REGISTRATION FEES
(includes Tickets to all convention events)
Amount
ADULT - In Advance (By September 29, 2017)
Includes Breakfast, Lunch & Dinner on Saturday, Breakfast on Sunday
$160.00
ADULT - After September 29, 2017 *Tickets available on site
Includes Breakfast, Lunch & Dinner on Saturday, Breakfast on Sunday
$180.00
YOUTH - In Advance (By September 29, 2017)
Includes Breakfast, Lunch & Dinner on Saturday, Breakfast on Sunday
$125.00
YOUTH - After September 29, 2017 *Tickets available on site Includes Breakfast, Lunch & Dinner on Saturday, Breakfast on Sunday $150.00

ALL UNITS 2017 ASSESSMENT FEES ARE $100.00

ASSESSMENT FEE PAYMENTS WILL BE RECEIVED DURING REGISTRATION


Section 3 - REGISTRANT AND DELEGATE LISTING
First Name MI Last Name
Register as: ADULT (In Advance) ADULT (On Site) YOUTH (In advance) YOUTH (On Site)
Dinner Meal Option
Delegate Role
Unit Officer Title


Use the submit button below to process the registration data you entered above.

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