Register at NPM.org


If registering by mail, please print. Only one person may be registered on each form. WINTER COLLOQUIUM REGISTRATION


CATEGORIES (choose one)


Premium (Includes 15% discount) Current Standard Member (+$50) Current Basic Member (+$130)


ADVANCE (12/1-1/14)


$335 $385 $465


REGULAR (1/15-2/6)


$375 $425 $505


Title (Mr., Ms., Rev., etc.) Street Address Daytime Phone


First Name City Fax Number


Last Name State E-Mail Address (required)


Badge Name (e.g. Tom for Tomas) Zip Code


PAYMENT Check # enclosed. Make payable to NPM in US Dollars or I authorize NPM to charge my credit card: Credit Card Number Expiration Date Name on Card (Please print clearly) Cardholder Signature Date of Signature


Cancellation Policy All cancellations must be requested by January 30, with a $100 processing fee due at that time.


Security Code (3 digits located on back of card, or 4 digits on front for AMEX)


Billing Zip Code


Mail printed registrations to:


NPM, 962 Wayne Avenue, Suite 550 Silver Spring, MD 20910


32 | 2022 NPM CONVENTION


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