APTA 2012 Bus & Paratransit Conference Student Registration Form

AMERICAN PUBLIC TRANSPORTATION ASSOCIATION

2012 BUS & PARATRANSIT CONFERENCE Mail to: Long Beach, CA Meetings Department APTA May 6 – 9, 2012 1666 K Street, NW Washington, DC 20006 FAX : 202-496-4331 or MEETING REGISTRATION FORM 202-496-4324

Member Registration: Your fee for the entire 2012 Bus & Paratransit To Register Online: Access the 2012 Bus & Paratransit Conference at Conference is $575 per person if payment is received by APTA on or http://apta.com/mc/bus/resources/Pages/Students.aspx before March 30, 2012 and after March 30 the registration fee is $625 per person. Important Dates: Cut off for your name on the Registration List – April 20, 2012 Student Registration: Student registration is free and includes admission Pre-registration ends – May 1, 2012 to: educational/technical sessions; the International Bus Roadeo; technical tours. To be eligible, the student must: i) be currently enrolled in a college, Non-member Registration: Non-members may attend for a special fee. university, or vocational school ii) complete this Conference Registration The special fee is the late registration fee plus $500 (Applied to dues if Form and fax the form along with a photocopy of his or her current you join within three months). Call APTA's Membership Department student ID to the number above. 202-496-4800 for details.

PAYMENT Please fill in this section. Enclose appropriate fee made payable to APTA. Registrations will not be processed without payment.

 $575 per person (on or before 3/30/12)  $625 per person (after 3/30/12)  Non-member $1,125 per person

 $125 per person Spouse/Guest Fee

 Check payments only  $0 Student Rate (please fax a photocopy of your valid student ID along with this form)

BADGE INFORMATION NOTE: Please complete registrant badge information carefully to avoid incomplete/incorrect information. Attach additional list if necessary. Bus Roadeo Awards Banquet Tickets 1.______Name ______The International Bus Roadeo Awards Banquet will be held Nickname Tuesday, May 8th from 7:00 – 9:00pm. If you would like to ______Title attend you must purchase a ticket. ______Company/University/College ______Tickets at $75 a piece = ______Address ______City, State, Zip If you would like to sit with your Roadeo Team please indicate ______this and your invitations will be filed with the Roadeo Team’s Tel: Registration packet so they can get you assigned seating at ______Fax: their table. Or you can have your invitation filed with your Bus ______Conference Registration Packet. E-mail ______ File with my Roadeo Team’s Registration Packet Spouse/Guest (if attending) (not applicable to fellow employees)  File with my Conference Packet (pickup at the Convention Center starting at 2:00pm on May 5).

SUBMITTED BY: Name______

Company______

Address______City, State, Zip______

Tel:______Fax:______

Please indicate if you have any disability for which you will require special accommodations:______