APCUG - Leadership Development Conference 2008 Registration Form

Join us the weekend of May 16th, 17th and 18th, 2008. The APCUG will host 2 days of workshops in West Nyack NY, 30 miles north of New York City. This is the first meeting of Eastern Regional Groups in over 10 years.

We look forward to having you attend. This conference promises to be filled with many worthwhile ideas and great contacts to help you run your club and increase your membership.

Registrant Name & Contact Information:

Full Name: *

Nickname on badge (usually first name only) *

Home - Street Address *

Home - City *

Home - Zip Code / Postal Code *

Home - State / Province *

E-mail address *

Home Phone #:

()

Cell Phone #:

()

Other Phone #:

()

If Position is not on the list, please indicate your Position

Please select your group from one of the Regional lists below. (If you belong to multiple user groups, please select the group that you want to appear on your name badge.)

If your group is not a current paid APCUG member group, then use the Other box at the end of the Regional listings. The fee for non-APCUG member groups paid by May 1, 2008 is $60.00; after May 1, the fee is $75.00.

If you have any questions about your membership, please contact membership@apcug.net.

Select your group from Region 1 (CT, MA, ME, NH, NY, RI, VT)

Select your group from Region 2 (DC, DE, MD, NJ, VA)

Select your group from Region 3 (OH, PA, WV)

Select your group from Region 4 (AL, GA, MS, NC, SC, TN)

Select your group from Region 5 (Florida)

Select your group from Region 6 (KY, IL, IN, MI)

Select your group from Region 7 (IA, MN, MO, ND, NE, SE, WI)

Select your group from Region 8 (AR, KS, LA, OK, TX)

Select your group from Region 9 (AZ, CO, NM, UT)

Select your group from Region 10 (CA > 93000)

Select your group from Region 11 (CA < 93000)

Select your group from Region 12 (AK, HI, ID, MT, NV, OR, WA, WY)

Select your group from International Region (includes Canada)

If your group is not in any of the above Regional lists, enter your group name here (please spell out completely and add City and State)

After you have completed your registration, click on submit and review your registration.

Print your confirmation form, and click on Confirm to select your method of payment (Check or Paypal).

Please enter the characters you see in this picture:

Characters

This helps prevent automated form submissions. If you are not sure what the characters are, make your best guess. You will have another try in the next screen.
Can't see the image? Click here for an audible version in English.

Need assistance with this form?