62nd Annual Convention & Expo Registration Form
*This form is for Convention Attendees only. If you are an Exhibitor, please do not use this form and contact Kim Cook to register.
*Registrant Name:
*Company:
NIADA Member #:      (if known)
*Mailing Address:
*City:     * Choose a state Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. West Virginia Wisconsin Wyoming    *Zip Code:		In Association With:
*Telephone Number:     Fax Number:
*Email Address:     Website Address:
Is this your first time to attend a NIADA Convention & Expo? Yes or No
Do you plan to make reservations at the Gaylord Texan Hotel ? Yes or No
Check All That Apply: NIADA Member NAFRD Member AFIP Member NADA Member
Are you primarily a Retail Dealer or BHPH Dealer?
*Required Fields
All attendees must be registered. No admittance to any event without a badge. If you require a special diet, please contact NIADA
Registration Packages     (Prices are per each attendee) Rate Qty. Total Education, Expo & Banquets Package - ( entry to All events ) Badge name(s): $ 495 $ Expo & Banquets Package - ( entry to all events Except educational sessions ) Badge name(s): Adult $ 250 $ Child (6-15yrs) $   95 $ Expo Only Package - ( entry to Expo Only - June 26 - 28 ) Badge name(s): $ 225 $   Total Amount Due $

Please Note: You will be asked for your credit card information on a secure later page of this registration process.

                  

In the event of cancellation, Written Notice must be received by June 14, 2008 for a full refund
minus a $25 cancellation fee. No refund will be given for cancellations received after June 14, 2008.