NASWA's Winter Policy Forum 2005

CONFERENCE REGISTRATION
This form is for vendor registration only. If you are a general participant, please click here for general registration information.

Vendor registration fee is $550.00 per vendor.
A Booth Package is $1500.00 and INCLUDES one vendor registration.
The fee for each additional vendor registrant is $450.00.

For registration questions or additional information contact the Event Manager, Nina Bustria at 202.434.8020 or nbustria@naswa.org.

Registration and payment deadline is January 31st.

* - Required Fields

This registration is for*	Booth Package ($1500.00) Vendor only ($550.00)
	Additional Vendor ($450.00)
First Name: *
Last Name: *
Organization: *
Title: *
Address Line 1: *
Address Line 2:
City: *
State: *
Zip: *
Phone: *
Extension:
Fax:
Email Address: *
Confirm Email Address: *
Special Accommodations:

Payment Information:
Purchase Order:
Purchase Order #:
Registration Fee mailed under separate cover:
Registration Fee will be paid on site:
Please mail payment to:	NASWA Winter Policy Forum
	444 N. Capitol St., Suite 142
	Washington, D.C. 20001-1512

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