American Legion Auxiliary s2

2012-2013 Mission Training Conferences Registration Form LOCATIONS Please select the location(s) you plan to attend by checking the box. November 3-4, 2012 Hartford, Connecticut October 27-28, 2012 Minneapolis, Minnesota January 12-13, 2013 Atlanta Georgia

November 3-4, 2012 Las Vegas, Nevada January 19-20, 2013 Indianapolis, Indiana

PERSONAL INFORMATION Please Type or Print in black ink. Each person attending a Mission training Conference must complete a Registration form.

First Name: Last Name:

Member#: Department:

Preferred Name for Name badge: Title:

Address:

City: State: Zip:

Phone: Email:

How many years have you been an American Legion Auxiliary Member?

Food Allergies or special needs:

REGISTRATION INFORMATION AMOUNT ENCLOSED Registration $57.00 $ Registration includes continental breakfast each day and one lunch

PAYMENT INFORMATION Check Check Number: Check received from: Check made payable to: National Treasurer, American Legion Auxiliary

Credit Card Type: (MasterCard or Visa ONLY)

Credit Card Number

Exp. Date: Security Code: The last three numbers in the signature panel on the back of the credit card. Is this your Credit Card? Yes No Name on Card: Billing Address: City: State: Zip:

EMERGENCY CONTACT INFORMATION This information is for American Legion Auxiliary purposes only and will not be shared. Emergency Contact Name (First and Last):

Daytime Phone Number: Evening Phone Number:

Address:

City: State: Zip:

PRE-REGISTRATION DEADLINE: Friday, October 5, 2012 (Hartford, Connecticut) EXTENDED Until 10/12 Friday, October 19, 2012 (Atlanta, Georgia & Indianapolis, Indiana) New Date! Friday, December 14, 2012 (Minneapolis, Minnesota) Friday, December 21, 2012 (Las Vegas, Nevada)

MAIL TO: American Legion Auxiliary ATTN: Event Planning – Mission Training 8945 N. Meridian Street Indianapolis, IN 46260

FAX/EMAIL: (317) 569-4502 or [email protected] Only those paying for their registration with a credit card will be accepted via fax or email. All others must be mailed with payment. Electronic Registration forms can be found: http://www.alaforveterans.org/members/conventions_meetings/Pages/missiontraining.aspx

QUESTIONS: [email protected] (317) 569-4500 HOUSING: Housing information for each confirmation can be found in the Mission Training Housing Document located on the website.

NO REFUNDS WILL BE ISSUED AFTER 14 DAYS PRIOR TO THE START OF EACH MEETING.