2nd 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________

 

Do you plan to attend the banquet on Wednesday night?

Yes ____________ No___________

 

Please Note the following:

Meal tickets for Ridgecrest must be purchased with registration. Meal tickets must not be purchased from the Ridgecrest staff. You must purchase them though Roxie Mack.

 

Additional banquet tickets must be purchased with registration. Banquet tickets will not be available for purchase at Ridgecrest.

 

Preregistration deadline is May 13, 2010-$50 before May 13 and $75 after.  There will be no refunds after May 5.

 

Please complete the following as applicable.

 

Member* Registration ($50) ____________________

(Includes Banquet)

Spouse or Guest Registration ($50) ______________

(Includes Banquet)

Meal Tickets ($60.00) each ____________________

Additional Banquet Ticket ($35 each) ____________

 (If needed)  

Membership Fee $20 _________________________

(If not a current member)

Late Member* Registration ($75) each ___________

Late Spouse or Guest ($75) each ________________

 

Total amount enclosed $________________________

 

Please make checks payable to NCPSMA and mail to NCPSMA, 630 Adams Ridge Road, State Road, NC 28676

 

Please read the very important information concerning the 2ndt Annual NCPSMA Western Convention Workshop in this issue of the Maintenance Beacon.

 

*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.