Print this page and complete one form per attendee/display table.

Completed forms should be received with payment no later than April 7, 2008.   (Last minute registration will also be available on the morning of the conference until all seats are filled.  Please bring completed form and payment.)

Please mail registration/payment to:

Cheryl Scher, Event Coordinator

c/o NHES

11350 Channel Road

Atlantic, VA 23303

Participant Information:

Name:

    Last                                                First                                        Middle Initial

Organization:

Address:

City:                                                                State:                                      Zip:

Telephone:                                                     Fax:

Email:

Would you like your email to be shared with conference attendees? YES  /  NO

Dietary need or disability that requires accommodation, please advise:

Fee, please Indicate: 

General Attendee $25

Student Attendee $12 (Please include copy of student ID)

Display Non-profit Table $25

Display For-profit Table $50

Total payment: $

Method of Payment (U.S. funds only):

Check or Money Order, make payable to NHES

or, Credit Card

Circle one:   VISA     MasterCard

Card Number: __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __

Expiration Date: ___ / ___ / ___

Cardholder Name:

Name, printed:

Authorizing Signature: _____________________________________________

Mailing Address if different from above,

Address:

City:                                                                State:                                      Zip:     

For Office Use,

Date Received:                               Check/MO #:                           Authorized: