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TennSACA |
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Message Board: Ideas for Your School Age Kids |
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Membership |
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TennSACA Conference 2009 |
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On-Line Conference Registration |
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TennSACA Spring Training 2006 |
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Sitemap |
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2009 School-Age Care Conference (TennSACA) Please PRINT LEGIBLY ALL information. Feel free to make copies of this registration form. ONE registration FORM for EACH INDIVIDUAL. Please make sure that you complete the membership information too. It is critical that we have your correct email address for news from TennSACA and NAA. NAME:__________________________________ Home Address:_______________________________ City:__________________ Zip:_________________ Home Phone#:( )__________ Work#:( )_________ Employer/Agency:________________________________ Work Address:___________________________________ City:__________________ Zip:____________________ Fax: ( )______________ Email:_________________ County:________________ Yrs. of Experience:_____ PLEASE CIRCLE THE APPROPRIATE AGENDA TennSACA MEMBER ONLY Both Days (Friday & Saturday) $130.00 Thursday Morning Seminar $ 40.00 Thursday Afternoon Seminar $ 40.00 Friday Only $ 80.00 Saturday Only $ 80.00 Membership Dues $_______ *Please remember to add your membership fees to the total amount due; complete the individual or agency information. TennSACA Member Total: $______________ If you are a non-member and wish to become a member of TennSACA/NAA, you may do so by completing the membership information and adding the membership fee to your registration. _____Yes, I want to become a member of TennSACA and NAA; my dues are included in my check. NON-MEMBER ONLY Both Days (Friday & Saturday) $175.00 Thursday Morning Seminar $45.00 Thursday Afternoon Seminar $45.00 Friday Only $115.00 Saturday Only $115.00 NON-Member Total: $__________________ Privacy Options __Please do not publish this information in the NAA Member Directory. __Please do not provide my information to outside organizations. MEMBERSHIP INFORMATION Please circle the appropriate level. Individual Membership $40.00/year (TennSACA & NAA) AGENCY MEMBERSHIPS LEVEL 1: 1-5 People $135.00 LEVEL 2: 6-10 People $280.00 LEVEL 3: 11-15 People $420.00 LEVEL 4: 16-20 People $560.00 LEVEL 5: 21-25 People $700.00 LEVEL 6: 26-30 People $840.00 LEVEL 7: 31-35 People $980.00 LEVEL 8: 36-40 People $1,120.00 Please list name(s) of designated people for membership. Everyone is now a member of TennSACA and NAA. Please feel free to use additional paper to list those members and their information. Name of Agency:________________________________ Agency Address:_________________________________ City:_________________________ Zip:____________ Phone Number: ( )____________________________ 1. Name:_______________________________________ Email:_________________________ 2. Name:________________________________________ Email:_________________________ 3. Name:________________________________________ Email:_________________________ 4. Name:________________________________________ Email:_______________________ 5. Name:________________________________________ Email:________________________ 6. Name:________________________________________ Email:________________________ 7. Name:________________________________________ Email:________________________ 8. Name:________________________________________ Email:________________________ SEND COMPLETED REGISTRATION FORM AND CHECK TO: TennSACA Conference P.O. Box 291692 Nashville, TN 37229-1692 A check must be sent with your completed form for you to be registered for the conference. NO REFUNDS. Have questions? Please call: 615-391-2270 or email: tonyamb@bellsouth.net FOR OFFICE USE ONLY: Agency: Date: Check #:_______ $______________ Number/Name of Individual(s):___________________ |
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