NASAA

2006 NASAA Leadership Institute

Registration Form

Please complete all fields.
Enter your name as you would like it to appear on your name badge.
Name:
Title:
Agency/Organization:
Address1:
Address2:
City:
State:
Zip:
Office Phone:
Office Fax:
E-mail Address:

Registration Fees

Workshops and peer sessions are designed for key SAA policy decision makers--directors, deputy or assistant directors, chairs and council members. Those groups should plan to participate. Agencies without deputies, or agencies with another staffer that would benefit from a policy-focused program, are welcome to register an additional individual.

Please select the appropriate fee:



Guest fee for evening events: $75    Guest name:

Invoicing

NASAA will invoice you or your agency.  Please indicate your preference below.

Invoice my state arts agency for registration and guest fee (if applicable)
Invoice my state arts agency for registration fee only
Invoice me


Planning Information

Sessions

Please select the session that you will be attending:

 Executive Director Institute
 Chair/Council Member Institute
 Assistant/Deputy Director Institute

Special Events

(Please select all that apply)

NASAA Opening Reception at the Native Heritage Center - Monday, September 18 (6:30 -8:30 p.m.)

 NASAA Closing Reception at the Anchorage Museum of History and Art - Wednesday, September 20 (6:30 - 8:30 p.m.)

NASAA Planning 

To enhance NASAA planning and your networking at the Fall Leadership Institute and throughout the year, please identify two or three looming challenges or issues you'd like to discuss with your colleagues. Note that your responses will be shared with attendees, and that each response should not exceed 75 characters.


1.

2.

3.

Other Information

 I am a vegetarian.
 I have other dietary needs.
(Please explain below, and NASAA will try to accommodate. A staff member will contact you before August 21, 2006, to discuss arrangements.)


 I need accommodations due to a disability.
(Please briefly describe your needs, so we can make every attempt to accommodate your requests. A staff member will contact you before August 21, 2006, to discuss arrangements.)


Optional contact information in case of an emergency:
Note: This information will be kept confidential by NASAA.
Name of emergency contact:
Daytime telephone number of contact:
Evening/weekend telephone number of contact:

You may also mail or fax this form to NASAA.

NASAA
1029 Vermont Avenue, NW
2nd Floor
Washington, DC 20005
202-347-6352
Fax 202-737-0526