Registration


gistration


NAME ___________________________________________________________ COMPANY _____________________________________________ NAME FOR BADGE ________________________________________________________________________________________________________ EMAIL ________________________________________________________________ PHONE ___________________________________________ ADDRESS _______________________________________________________________________________________________________________ CITY _________________________________________________________ STATE _______________________ ZIP _________________________ SPOUSE/GUEST NAME FOR BADGE _________________________________________________________________________________________ EMERGENCY CONTACT NAME _______________________________________ EMERGENCY CONTACT PHONE __________________________


REGISTRATION FEES (Full registration includes the Excom Meetings, Welcome Reception, Technical Sessions, Poster Sessions, Exhibits, and Lunch and Breaks on Saturday, Monday, and Tuesday)


AIPG Member Full Registration Non-Member Full Registration


Young Professional Full Registration (must be AIPG YP Member) Daily Registration Sat Sun Mon Tues Spouse/Guest Full Registration


Spouse/Guest Welcome Reception Only


Student Full Registration / with Sat., 9/23/17 Student Career Day Student Daily Registration Sun Mon Tues


Student Attend Career Day Only (Sat., 9/23/17, Students Only) TOTAL AMOUNT DUE


FIELD TRIPS (must be registered for the conference)


General Jackson Cruise, Dinner, and Show (Fri., 9/22/17, 5:30 pm - 10:30 pm)


Mammoth Cave, Crumps Cave and


Corvette Museum Tours (Sun., 9/24/17, 7:30 am - 6:00 pm)


Harpeth River and Stones River Trip (Sun., 9/24/17, 7:30 am - 6:00 pm)


Lookout Mountain and Raccoon Mountain (Mon., 9/25/17, 7:00 am - 5:00 pm)


Big South Fork National River & Recreation (Mon., 9/25/17, 7:00 am - 5:00 pm) Cancelled


Castalian Springs Mound Site and


Wynnewood Museum Tour (Mon., 9/25/17, 8:00 am - 1:00 pm) Cancelled


Gordonsville Underground Zinc Mine Tour (Tues., 9/26/17, 7:00 am - 5:00 pm)


Jack Daniel’s Distillery Tour (Tues., 9/26/17, 8:00 am - 2:00 pm) Cancelled


TOTAL AMOUNT DUE $


Acceptance of Terms: I understand that by registering for the 2017 AIPG Confer- ence and Exhibition, I release and agree to indemnify the American Institute of Pro-   which arise out of or result from my attendance at the AIPG National Conference, whether or not foreseeable, including, without limitation, personal injuries to me or      app, of me and/or my products, for conference related publicity (e.g., website, TPG, 


Cancellation Policy:  -  No refunds can be issued for cancellations after September 15, 2017 or for no-shows   


www.aipg.org $99 $ $139 $99 $99 $ $ $


AMOUNT TOTAL $109


$ EARLY BIRD


(Before or on 9/8/2017) $425 $475 $300 $250 $225 $45


$145 / $160 $95 $15


REGISTRATION (After 9/8/2017)


$525 $575 $400 $350 $325 $45


$ $ $ $ $ $


$145 / $160 $ $95 $15


$ $ $


 AMOUNT TOTAL Welcome Reception (Sunday) (please check if attending, included with registration) AGI Workshop - Creating Meaningful Experiences in School Settings (Mon) 


AIPG Awards and Dinner (Monday) Please select your dinner choice:    


Make a Donation to the Foundation of the AIPG


TOTAL AMOUNT DUE TOTAL AMOUNT DUE (from all sections) TOTAL


$70


$


$


$ $


$


PLEASE CHECK METHOD OF PAYMENT      (Credit cards are processed in US dollar amounts only)


Card No._________________________________________________  Print name of cardholder ____________________________________


 city, state, and zip) ________________________________________ ________________________________________________________


Hotel Information:           of $149+ tax per night, which will be honored until 9/1/17.


Send completed form to: American Institute of Professional Geologists (AIPG) 12000 Washington Street, Suite 285, Thornton, CO 80241 cld@aipg.org, fax (303) 253-9220, phone (303) 412-6205 Register on-line at www.aipg.org.


Jul.Aug.Sep 2017 • TPG 5


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