42nd Annual Conference

National Association of Women Highway Safety Leaders

Savannah, Georgia

August 26-29, 2009

Conference Registration Form

Your advance registration is important for conference planning and for preparing the roster of participants. You will want to be included!

Please print this form and return with your check made payable to NAWHSL to:

Judi Keippel, 2743 N. Albany, Chicago, IL 60647

Phone: 773 278-8476   Fax: 773 278-7135   Email: judikeippel@yahoo.com

Note: All registrations must be received by July 24, 2009.  Attendees, quests, and exhibitors are all required to fill out a registration form.

Please print or type

Name:  ______________________________________________________________

NAWHSL State Affiliation: _______________________________________________

Organization:   ________________________________________________________

Address:    ___________________________________________________________

City:  ____________________________    State:  _________   Zip Code  _________

Telephone  ________________   FAX  ______________  Email _________________

Meal Restrictions   _____________________________________________________

Emergency contact & phone    ____________________________________________

               Conference Registration includes all sessions, materials, and meals.

                                 (Does not include Friday afternoon & evening activities)

   

Member/Exhibitor

Non-Member

$275.00

$300.00

$____________

$____________

Member/Exhibitor

Non-Member

$300.00

$325.00

$____________

$____________

Saturday Night Banquet Only

Registration - After July 24, 2009

Advanced Registration - Prior to July 24, 2009

$  80.00

$____________

Total Due

$____________

Exhibitor's Fee

Spouse/Guest (of registered attendees/exhibitors)

Tour of Savannah (optional) -- per person

$200.00

$100.00

$  26.00

$____________

$____________

$____________

  Followed by Dinner at Paula Deen's Restaurant (off menu/own expense)