Summit 2010

Summit Registration

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Registration Form

First Name:
Last Name:
Credentials:
(if any used)
Position/Title:
Organization:
Address1:
Address2:
City:     State:
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Fax:
Email:
Name of Spouse/Personal Guest:

REGISTRATION FEES
ACMHA Member Summit fees paid via MasterCard and Visa are accepted but incur a 2.5% surcharge, listed on the invoice as "Shipping." (Note: 2011 ACMHA dues must be paid by January 31 to be eligible for this rate.) $450.00
Non-Member Professional Summit fees paid via MasterCard and Visa are accepted but incur a 2.5% surcharge, listed on the invoice as "Shipping." $600.00
Spouse/Significant Other Summit fees paid via MasterCard and Visa are accepted but incur a 2.5% surcharge, listed on the invoice as "Shipping." (Note: Meal/Social events only) $275.00
Wednesday Only Registration Summit fees paid via MasterCard and Visa are accepted but incur a 2.5% surcharge, listed on the invoice as "Shipping." $300.00
Thursday Only Registration Summit fees paid via MasterCard and Visa are accepted but incur a 2.5% surcharge, listed on the invoice as "Shipping." $300.00

Registration fee entitles attendees to all program materials and handouts, refreshment breaks, scheduled meals, and social functions.

First Time Attendee (Please check this box if this is your first ACMHA Summit)
I require vegetarian meals