INVOICE #0900
2009 SMSA Conference Registration Form

Please use one form per person and print clearly!

The SMSA Conference will begin on Friday again this year with Professional Development Workshops for
Administrators and Instructors/RiderCoaches on
FRIDAY ~ August 21, 2009
2:00 - 5:00 PM

Pre-Registration Required - See registration form below

Full Name:
First name or nickname:
used for name tag
Title:
used for name tag
Representing:
Address:
City:
State:
Zip Code:
Phone:
Fax:
Email:


Please check all events you will attend.  Any items not checked will be on your own.
Tickets will be issued at the conference.
(Tickets cannot be guaranteed for those who register after August 1, 2009)

Early registration deadline is July 21, 2009.

Late registration fee applies if postmarked after July 21, 2009.  Credit cards, checks, money orders or purchase orders are acceptable.  To pay by credit card you must use the on-line registration feature.  Only written refund requests will be considered.  A $25 processing fee will be deducted from all refunds.  No refund requests will be accepted after August 1, 2009.

Fee includes:  Admission to conference activities,
one t-shirt, one conference bag and meal functions for one person

Please indicate your shirt size here:    S_____ M_____ L_____ XL_____ XXL_____XXXL_____

We cannot guarantee your shirt size will be available however, we will make every effort to provide the requested size or the next larger size.

DESCRIPTION: COST:   #  of
attendees

TOTAL
COST: 

SMSA MEMBERS - Early Registration Fee*

  $170    $__________
NON-SMSA MEMBERS - Early Registration Fee  $195    $__________
SMSA MEMBERS - Late Registration Fee*  $195    $__________
NON-SMSA MEMBERS - Late Registration Fee  $220    $__________

*SMSA Voting, Corporate, Professional and Supporting Associate Members are allowed up to two discounted conference registrations as a benefit of their membership.  SMSA Supporting and Emeritus Associate Members are allowed one discounted conference registration as a benefit of their membership.

      

If you are requesting discounted membership conference registration fees, please indicate your membership status below

 

 

 

       SMSA Voting Member State of ________________________________________
  SMSA Corporate Member Corporate Name _________________________________
  SMSA Professional Member Organization Name _______________________________
  SMSA Supporting Associate Member Organization Name _______________________________
  SMSA Supporting Member
  SMSA Emeritus Associate Member  

 

    

Friday - Business Meeting Only Lunch
This lunch is not included in the conference registration fee.  All Business Meeting attendees & their guests attending this function will be charged $10 each.  No lunch tickets will be available for sale on-site.

  $10    $__________
Friday, Instructor/RiderCoach Appreciation Reception - Self  NC    NA
Friday, Instructor/RiderCoach Appreciation Reception- Guest  $15    $__________
Saturday, Lunch - Self  NC    NA
Saturday, Lunch - Guest  $20    $__________
Saturday Evening Event & Dinner - Self  NC    NA
Saturday Evening Event & Dinner - Guest  $25    $__________
Sunday, Lunch - Self  NC    NA
Sunday, Lunch - Guest  $20    $__________
TOTAL PAYMENT INCLUDED:      $__________
TOTAL TO BE INVOICED:      $__________


By my signature below, I authorize SMSA to invoice the following for conference registration fees due:
  Print Name: 
  Sign Name:
  Name of Organization or Individual to be invoiced:

  Mail invoice to:  (provide complete mailing address)

 

 

       

YES, I Would Like a Receipt (receipts cannot be provided until full payment has been received)

SMSA, in conjunction with the National Highway Traffic Safety Administration will be providing Professional Development Workshop sessions
as follows:
(There is no additional cost to attend PDW sessions)

Friday, August 21, 2009
2:00 pm - 5:00 pm

YOUR COMPRESENSIVE STATE MOTORCYCLE SAFETY PROGRAM
For Administrators

MEDIA TRAINING
For Administrators and Instructors RiderCoaches

Administrators and Instructors/RiderCoaches must sign up in advance to attend the PDW sessions.
Space is limited


Yes, I would like to attend the Professional Development Workshop for:

Your Comprehensive State Motorcycle Safety Program
Administrators_______

Media Training
Administrators and Instructors/RiderCoaches_______
Name:
Title:
Email address or phone#

Don't normally register for the conference until your new fiscal year beginning July 1st???

DON'T DELAY


Register now and indicate your request for an invoice for payment of conference registration fees on your registration form.  This will enable to you to sign-up early and get scheduled for the PDW sessions.

If you would like to submit your conference registration without payment prior to the beginning of the July 1st fiscal year, you must register using this conference registration form and submitting via mail to the SMSA.  You will not be able to use the on-line conference registration feature as a credit card is required to complete those transactions.

To take advantage of the early registration via invoice, please complete your registration form, including PDW sign-up information, if applicable, and submit to the SMSA.  Make sure to indicate on your registration form that an invoice is requested for payment of your registration fees.

If you have any questions, please contact the SMSA Business Office as follows:

Phone:  303-797-2318
Email:  smsabusinessmgr@smsa.org

PLEASE MAIL COMPLETED REGISTRATION FORM AND CHECK PAYABLE TO SMSA TO:

SMSA Business Office
7881 S. Wellington Street
Centennial, Colorado 80122-3193