2011 NATARI Crash Conference:
Pedestrian / Bicycle Collisions

Registration

IMPORTANT: If NOT registering online with a credit card, please print and mail completed form with your check payable to NATARI to: NATARI, c/o Marc Reider, 1301 Limekiln Road, Douglassville, PA  19518-8811

*Indicates Required

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


MdATAI

NAPARS

NJAAR

NATARI

NYSTARS

 

 

Will you be bringing an oversized vehicle with special parking requirements?

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:

 

 

Also register me for the Digital Photography class, Tuesday October 4 for an additional $55 (includes lunch)

Yes

No

 

 

Also register me for the ACTAR Prep class, Monday October 3 for an additional $100 (includes lunch)

Yes

No

 

 

A banquet will be provided for all registered attendees on Thursday, October 6, 2011.

Will you be attending the banquet?*

Yes

No

 

 

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


Number of guests for ONLY the Thursday evening Banquet – $35.00*

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 / Class Fees $
Total Submitted: $

Members $355         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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