Registration Form

(please print and mail in)

Name_____________________________________ญญญญญญญญญญญญญญญญญญญญญญ___________________________

Address______________________________________________________________

City/State/Zip_________________________________________________________

Phone________________________________Fax_____________________________

Email________________________________________________________________

Topic areas/questions for Legislative session (add page or post on web site as wanted)________________

 

 

Annual Conference Fee                                 $__________

NMSEA Membership Fee                                 __________

Lodging   (type_______ X # of persons ___)                     __________

Camping/Tenting                               __________

Food (Circle ea: Fri: D; Sat: B L D; Sun: B) X #___persons       __________

Vegetarian: Yes___    No___

Special Needs      _____________________________

________________________________________

                        Total Fees        $__________

 

If paying by credit card please circle one Visa        MasterCard

Full Name on Card____________ Card #___________________ Expiration Date___________

 

Please send check or Money Order including all fees by July 31st to :

NMSEA, P.O. Box 36180,  Albuquerque, NM  87176

For more information contact NMSEA:  WWW.NMSEA.ORG, or 1-888-886-6765.