NYSNA 63rd ANNUAL CONFERENCE 2014 REGISTRATION FORM - OCTOBER 31-NOVEMBER 2 The Saratoga Hilton & Saratoga Springs City Center LOOK FOR THE EARLY BIRD RATES BELOW!! DON’T WAIT.

PLEASE NOTE A SEPARATE REGISTRATION FORM IS REQUIRED FOR EACH INDIVIDUAL. SUBMIT THIS FORM WITH CHECK OR PURCHASE ORDER PAYABLE TO NYSNA BEFORE OCROBER 1, 2014 AND MAIL TO:

NYSNA QUESTIONS, PLEASE CALL 125 WOLF ROAD, SUITE #312 1-(800)-697-7372 ALBANY, NEW YORK 12205 Fax: (518)-446-0113 (If you are using a Purchase Order, please attach it to this Registration Form.)

NAME:______TITLE:______

NAME (Nickname) ON BADGE:______ARE YOU A BUYER:______EMAIL :______

SCHOOL DISTRICT:______ADDRESS:______

CITY:______STATE:______ZIP:______

SCHOOL/BUSINESS TELEPHONE: (_____)______

NYSNA MEMBERSHIP NO.:______HOME PHONE: (______)______

ATTENTION: C & D LEVEL NYSNA MEMBERS (STAFF ONLY) RATES

SATURDAY ONLY "DAY-TRIPPER" SPECIAL MUST BE PRE-REGISTERED BY OCT 1ST. _____$ 50 Includes General Sessions, Exhibits, Workshops. NO Meals Included.

2014 Extra Special – Register 9 staff for Saturday, by Oct. 1st and get the 10th one for FREE! _____ $450 (for 10) Registrations must all be sent in at once; one form per registrant.

PLEASE TAKE ADVANTAGE OF OUR EARLY BIRD RATES: EARLY BIRD LATE MEMBER MEMBER NON-MEMBER BEFORE OCT. 1 AFTER OCT.1 RATE FULL CONFERENCE – FRIDAY- SUNDAY. Includes all General Sessions, Exhibits, choice of workshops, and FULL MEAL PACKAGE.: ** ___$375 ____$400 ____$450

ONE DAY ATTENDANCE - INDICATE CHOICE BELOW. Includes on the day chosen: General Sessions, Exhibits (Fri/Sat) & Workshops Check day attending: Friday ______or Saturday______or Sunday ______$175 ____$200 ____$250

Retirees/Guest Special – Registration rate for family member, retired members and School Business Officials. Current food service employees are not eligible for this rate. _____$ 60 _____$120 _____$180 Separate form required for each guest. Pre-registration requested. No meals included. one day 2 day 3 day

Check day/s attending: Friday _____Saturday _____ Sunday______

If purchasing meals separately, circle meal choices:

FRI. DINNER $55 SAT. BREAKFAST $24 SAT. RECEPTION/DINNER $60 SUN. BREAKFAST $24 **FULL MEAL PACKAGE $ $163.00

NO REFUNDS DUE TO CANCELLATION AFTER OCTOBER 1, 2014. “NO SHOWS” WILL BE BILLED. Registration total: $_____ ......

FOR OFFICE USE ONLY: Amt. Received:______Date:______PO#:______Check #:______

Purchase Order Information: Date P.O. Paid: ______Amount:______