Preferred First Name for Badge

Professional Development Course Registration STUDENT INFORMATION Population Management I: Data Acquisition and Processing Last Name FebruaryAZA Professional 12-17, 2018Development – Wheeling, WV Course Policies* First Name Preferred First Name for Badge REGISTRATION: Registration and payment does not constitute Middle Initial acceptance in the course. Registrants will be notified of acceptance decisions beginning three (3) months prior to Former/Maiden Name (if applicable) course start date. Enrollment priority is given to current AZA AZA Individual Member Number Individual Members and other groups as indicated by course. If a course fills, applicants will be placed on a waiting list and OR Membership application included contacted if space becomes available. Checks sent for course Zoo/Aquarium/Institution payment will be cashed immediately upon receipt as per standard business practices. Cashing your check does not Your Title (e.g.: Curator) indicate that you have been accepted into a course. You will Address receive an acceptance letter or waitlist letter once acceptance decisions are made. (Institution address preferred) City PAYMENT & REFUND: All payments must be made in U.S. State/Province funds, drawn on by a U.S. bank, and payable to AZA. The full registration fee and any credit fees will be refunded for Zip/Postal Code waitlisted applicants who are not admitted. All other refund Work Phone ext. requests must be received in writing no later than 4 weeks prior to the course start date. Refunds will not be issued for Cell Phone cancellations made after this date or for no shows. Refunds will Email be issued within 45 business days after the course ends. A $50.00 processing fee will be deducted for any cancellations, Administrator Email but will be waived for refunds from the waiting list. (to receive receipt) Substitutions from the same institution will be accepted without penalty, but must be provided in writing and approved Emergency Contact Name*: by AZA staff. Please email cancellation or substitution requests Emergency Contact Number*: to [email protected]. Dietary Restrictions: Photographs taken during the course may be used for promotional and educational purposes. I have read and agree to the: AZA Professional Development Course Policies* PAYMENT INFORMATION PAYMENT MUST ACCOMPANY THIS FORM

Paying by Check (include with this form) All fees are payablePlease to AZA mail and orcan emailbe included completed on a single registrationOn form or beforewith payment November to AZA 20, 2017:Professional Early Bird Development: Rates check. Association of Zoos and Aquariums, 8403 EBColesville Member Road, Tuition Suite –710, $875 Silver Spring, MD 20910 (E) [email protected] (T) 301.562.0777 x240 Paying by Purchase Order (include with this form) EB Nonmember Tuition – $975 Payment must be received within 30 days or registration will be cancelled. After November 20, 2017: Regular Rates PO#/Check# Total Amount $ Member Tuition – $975 Contact AZA for international wire transfer instructions. Nonmember Tuition – $1075 To pay by credit card, login to MyAZA at www.aza.org at go to MyEvents SAVE BY JOINING AZA! Not an AZA Individual Member? Save on the cost of registration by joining for as little as $80. To learn more, visit www.aza.org/individual-benefits

Enrollment Priority until 08/07/10 for AZA Individual Members and AZA Studbook Keepers