2010 MdATAI Crash Conference: Trailer Underrides

Registration

IMPORTANT: If NOT registering online with a credit card, please print and mail completed form with your check payable to MdATAI to: MdATAI, P.O. Box 903, Pasadena, Maryland 21123

First Name:*
M.I.:
Last Name:*
Company:
Address:*
City:*
State/Province:*
Zip:*
Daytime Phone:*
Evening Phone:*
Email:*
Member Of:


MdATAI

NAPARS

NJAAR

NATARI

NYSTARS

PSFM

Will you be bringing an oversized vehicle with special parking requirements (i.e. height exceeds 7 feet)?

Yes

No


Do you wish to be included in the attendee directory?*

Yes

No


ACTAR Number for CEU Credit:

How would you like your information to appear on your Conference ID badge?
Name:*
Company Name:
City and State/Province:

A buffet banquet will be provided for all registered attendees on Thursday, October 7, 2010.

Will you be attending the banquet?*

Yes

No

Also register me for the PSFM Forensic Mapping Class, Tuesday October 5 for an additional $45 (includes lunch)

Yes

No

Number of guests for the Full Meals & Crash Test Package – $95.00*


Number of guests for ONLY the Thursday Buffet-Banquet – $30.00*

Guests to the crash test exercise must be at least 18 years of age and sign a waiver. Please check our conference website for additional information – www.crashconference.com


Primary Guest Name:

Total cost to submit (optional if paying online):
Conference Fee $
Additional Banquet Attendees Fee $
Total Submitted: $

Members $345         Non-members $395


Payment Options:
- OR -

Questions? E-Mail Us or call (410) 360-8140



 

Do NOT complete – Office use only

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