Register by Mail

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Mail To:
Registration Services
The University of Alabama
Box 870398
Tuscaloosa, AL 35487

Please submit this entire page for your registration. For multiple registrations, please duplicate this form.

[ ]Mr. [ ]Ms. [ ]Dr. First:____________________________Middle Initial:________Last:____________________________

Preferred Name/Nickname:____________________________

Company/Organization Name:____________________________

Mailing Address:____________________________City:____________________________State:________Zip:______________

Email Address:____________________________Phone:____________________________

Job Title:____________________________

[ ] Enclosed is a check for $____________________________ made payable to THE UNIVERSITY OF ALABAMA

[ ] Purchase order is attached.

[ ] Charge $____________________________to credit card: [ ] MasterCard [ ] VISA [ ] American Express [ ] Discover

Card #____________________________Exp. Date (M/Y)____________________________

Security / Verification / CVV Code____________________________(Three or four digit code on back or front of credit card.)

Authorizing Signature:____________________________

Location of Conference:
DoubleTree by Hilton, 919 7th St, Greeley, CO 80634

Please enroll me in the following: (Program # 03-645-20)

APPLICABLE FEES:

[ ] $250 RNO Member Registration

[ ] $250 Early Bird Rate (Must be postmarked by May 1, 2020)

[ ] $175 Student Early Bird Rate (Must be postmarked by May 1, 2020)

[ ] $300 Standard Registration (non-member after May 1, 2020)

[ ] $200 Student Standard Rate (after May 1, 2020)

[ ] $25 Opening Reception Guest

OPTIONAL POST-CONFERENCE EXCURSIONS (PICK ONE:)

[ ] $100 Rocky Mountain national Park Tour*

[ ] $40 Self-Guided Tour of Estes Park, Colorado*

*See full excursion descriptions at www.irnc.ua.edu

 
A certificate verifying attendance and contact hours will be issued to all participants.

Note: The University of Alabama is committed to complying with the Americans with Disabilities Act. Requests for accommodation of physical and/or dietary needs should be made at least 30 calendar days in advance of the program date. Please email your request to stalantis@ccs.ua.edu. A portion of the invoice amount for this program will go to the Capstone Lifelong Learning Foundation to support activities of The University of Alabama and the College of Continuing Studies. Need our STAARS Vendor Number? Please use VC000118827 for UA College of Continuing Studies.

Questions? Contact Sea Talantis at 205-348-3014 or email stalantis@ccs.ua.edu or Mandy Guin at 205-348-6222 or mguin@ccs.ua.edu.