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Third Annual NCPSMA Western Convention Workshop Registration Form for Regular* Members & their Spouses and/or Guests
Please Print
Name ___________________________________________ Spouse/Guest name(s) (if registering) _________________ Address __________________________________________ City, State, Zip ____________________________________ Name of School System (LEA) _______________________ Office Phone #______________ Fax #_________________ E-Mail Address___________________________________
Important Needed Information Will you be staying overnight at Ridgecrest or will you be a daily commuter? Please check one. Staying at Ridgecrest _______ Daily Commuter________
Please Note the following: Meal tickets for Ridgecrest must be purchased with registration. Meal tickets will not be available for purchase at Ridgecrest.
There will be no refunds after May 13.
Please complete the following as applicable. Member* Registration ($50) ____________________ (Includes Vendor Reception) Meal Tickets ($60.00) each ____________________ Membership Fee $20 _________________________ (If not a current member) Late Member* Registration $75 each
Total amount enclosed $________________________ Please make checks payable to NCPSMA and mail to NCPSMA, 630 Adams Ridge Road, State Road, NC 28676. *Regular Members are those currently employed in a NC Public School System. All others must register through Roxie Mack at 336.366.4939 or rrm1@surry.net.
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