NYCAEYC Registration Form

ONLINE CONFERENCE REGISTRATION FORM

NYCAEYC 2012 Annual Conference * Saturday, February 11, 2012 * Food and Finance High School
Payments for online registration can be made via credit card or through a PayPal account.
* red asterisk indicates a required field

* Your First name

Your Middle name

* Your Last name

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Organization

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* Registration type individual group

Business/Organization (if materials are being mailed to your business address)

* Street Address

Apt. or Suite #

* Please indicate home business

* City

* State

* ZIP code

* Daytime telephone (including area code)
(in xxx-xxx-xxxx format)

Evening telephone (including area code)
(in xxx-xxx-xxxx format)

Cell Phone (including area code)
(in xxx-xxx-xxxx format)

* Email Address

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(Important! Your registration confirmation will be e-mailed to this address.)

NYCAEYC members: If NYCAEYC cannot verify your membership, this will delay the processing of your registration.
If you need to verify that your membership is active and/or to get your Member ID# and expiration date,
please call the NYCAEYC office at 212-807-0144, or e-mail office@nycaeyc.org.

If student, specify your College

Student ID #

NYCAEYC membership ID# (numbers only)

NYCAEYC membership expiration date
(in mm/dd/yyyy format)

* REGISTRATION FEES Register by January 15th, 2012 for Early Bird Savings!

	Early Bird before January 15, 2012	On or Before February 6, 2012	On-site February 11, 2012
FRIDAY NIGHT ONLY
NYCAEYC MEMBER	$35 per person	$35 per person	Not available
STUDENT MEMBER	$20 per person	$20 per person	Not available
NON-MEMBER	$50 per person	$50 per person	Not available

SATURDAY ONLY
NYCAEYC MEMBER	$125 per person	$145 per person	$175 per person
STUDENT MEMBER	$75 per person	$90 per person	$125 per person
NON-MEMBER	$185 per person	$210 per person	$240 per person
PRIMARY PRESENTER	$0 per person	$0 per person	$0 per person

FRIDAY AND SATURDAY
NYCAEYC MEMBER	$150 per person	$170 per person	Not available
STUDENT MEMBER	$85 per person	$100 per person	Not available
NON-MEMBER	$225 per person	$250 per person	Not available
PRIMARY PRESENTERS
Student	$20 per person	$20 per person	Not available
Member	$35 per person	$35 per person	Not available
Non-Member	$50 per person	$50 per person	Not available

		TOTAL AMOUNT DUE:	$0

REFUND POLICY Registration refund requests must be in written form and will be honored only if postmarked by January 30, 2011. NYCAEYC refund policies preempt any policies associated with your payment through PayPal. A $25 processing fee will be deducted from all refunds. Fees are non-refundable after February 1, 2012.