NYAPSA CONFERENCE REGISTRATION FORM
Print the form below and mail it with your payment. Complete one form per registrant please.
Fill in your name, title, and organization as you would like it to appear on your conference name tag.
Name: _________________________________________________
Title: __________________________________________________
Organization: __________________________________________
Address: _______________________________________________
Phone: ____________________________________ Email: _______________________________
Please indicate the meal function(s) you will be attending:
__ Lunch, Sunday Oct. 20 __ Continental Breakfast, Monday Oct 21 __ Lunch, Monday Oct. 21
If you require a vegetarian meal check here: ___
REGISTRATION FEES
[NOTE: Hotel reservations must be made directly with the Hilton Garden Inn - see info here]
FULL CONFERENCE REGISTRATION:
Postmarked by Sept. 20: Postmarked after Sept. 20:
Member: o $130.00 Member: o $150.00
Non-Member: o $160.00 Non-Member: o $180.00
ONE DAY REGISTRATION:
Postmarked by Sept. 20: Postmarked after Sept. 20:
Member: o $100.00 Member: o $120.00
Non-Member: o $135.00 Non-Member: o $155.00
If registering for one day only, which day will you be attending?
__ Sunday __ Monday
Total amount enclosed: _______
Make check payable to: NY Association of Pretrial Service Agencies
Mail this form with your check or voucher to:
Aida Tejaratchi, NYAPSA Treasurer
c/o CJA
299 Broadway, 4th Floor
New York, New York 10007
Questions? Contact Craig McNair at (585) 454-7350, cmcnair@monroecounty.gov
Print the form below and mail it with your payment. Complete one form per registrant please.
Fill in your name, title, and organization as you would like it to appear on your conference name tag.
Name: _________________________________________________
Title: __________________________________________________
Organization: __________________________________________
Address: _______________________________________________
Phone: ____________________________________ Email: _______________________________
Please indicate the meal function(s) you will be attending:
__ Lunch, Sunday Oct. 20 __ Continental Breakfast, Monday Oct 21 __ Lunch, Monday Oct. 21
If you require a vegetarian meal check here: ___
REGISTRATION FEES
[NOTE: Hotel reservations must be made directly with the Hilton Garden Inn - see info here]
FULL CONFERENCE REGISTRATION:
Postmarked by Sept. 20: Postmarked after Sept. 20:
Member: o $130.00 Member: o $150.00
Non-Member: o $160.00 Non-Member: o $180.00
ONE DAY REGISTRATION:
Postmarked by Sept. 20: Postmarked after Sept. 20:
Member: o $100.00 Member: o $120.00
Non-Member: o $135.00 Non-Member: o $155.00
If registering for one day only, which day will you be attending?
__ Sunday __ Monday
Total amount enclosed: _______
Make check payable to: NY Association of Pretrial Service Agencies
Mail this form with your check or voucher to:
Aida Tejaratchi, NYAPSA Treasurer
c/o CJA
299 Broadway, 4th Floor
New York, New York 10007
Questions? Contact Craig McNair at (585) 454-7350, cmcnair@monroecounty.gov