41stAnnual NCPSMA Eastern
Convention/Workshop
September 25-27, 2013
Crystal Coast Civic Center
Morehead City, NC
*Regular Member or Retired Regular Member
Registration Form
Please Print
Name __________________________________________________
Spouse/Guest name(s) (if attending banquet)
_________________
Address
________________________________________________
City, State, Zip
__________________________________________
Name of School System (LEA)
_____________________________
Office Phone #_________________ Fax
#____________________
E-Mail
Address_________________________________________
I wish to register as follows:
Member Registration ($60)
each
$____________
Includes lunch on Thursday and Friday.
Banquet tickets must be purchased separately.
Banquet Ticket ($10) each
$____________
Spouse or Guest Banquet Ticket ($10)
each
$____________
Preregistration deadline is August 15, 2013
Late Registration Fee (After August 15, 2013)
Member ($70)
each
$
____________
Includes lunch on Thursday and Friday.
Banquet tickets must be purchased separately.
Banquet Ticket ($10)
$_____________
Spouse or Guest Banquet Ticket ($10)
each
$_____________
Total Enclosed
$_____________
There will be no refunds after (August 30,
2013)
Please make checks payable to NCPSMA
and mail to
NCPSMA, 630 Adams Ridge Road, State Road, NC 28676.
LEA's sending one check for multiple registrations need not fill out individual
registration forms.
A single sheet listing the individual names of those they wish to register
along with the LEA name,
address, phone number, fax number and contact person will be sufficient.
* Employed by or retired from a NC Public School System.
All others must register through Roxie Mack at 336 366 4939 or rrm1@surry.net.
