<p> 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</p><p>November 3-4, 2012 Las Vegas, Nevada January 19-20, 2013 Indianapolis, Indiana</p><p>PERSONAL INFORMATION Please Type or Print in black ink. Each person attending a Mission training Conference must complete a Registration form.</p><p>First Name: Last Name: </p><p>Member#: Department: </p><p>Preferred Name for Name badge: Title: </p><p>Address: </p><p>City: State: Zip: </p><p>Phone: Email: </p><p>How many years have you been an American Legion Auxiliary Member? </p><p>Food Allergies or special needs: </p><p>REGISTRATION INFORMATION AMOUNT ENCLOSED Registration $57.00 $ Registration includes continental breakfast each day and one lunch</p><p>PAYMENT INFORMATION Check Check Number: Check received from: Check made payable to: National Treasurer, American Legion Auxiliary</p><p>Credit Card Type: (MasterCard or Visa ONLY)</p><p>Credit Card Number </p><p>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: </p><p>EMERGENCY CONTACT INFORMATION This information is for American Legion Auxiliary purposes only and will not be shared. Emergency Contact Name (First and Last): </p><p>Daytime Phone Number: Evening Phone Number: </p><p>Address: </p><p>City: State: Zip: </p><p>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)</p><p>MAIL TO: American Legion Auxiliary ATTN: Event Planning – Mission Training 8945 N. Meridian Street Indianapolis, IN 46260</p><p>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</p><p>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.</p><p>NO REFUNDS WILL BE ISSUED AFTER 14 DAYS PRIOR TO THE START OF EACH MEETING.</p>