2016 CMS Conference: Click for United States Advance

37th Annual Conference Registration

First Name
Last Name
Badge Name
Company

Please enter your mailing address below -This address needs to match DD2345 for proceedings to be issued.

 

Address
City
State
Zip


Please enter a Unique Email Addresses for All Attendees

Email
Phone 123-456-7890
Fax

Do you want to be listed on the published attendee list?
 Yes  No
 
DD2345 Certification #, If Government enter NA
DD2345 Expiration Date

As a reminder "each registrant must provide proof of citizenship each year they attend."

U.S. Citizen
 Yes
 No (STOP) You Must be a US Citizen to Attend This Conference

Please chose a classification
 Government Employee
 Academia
 Corporate

Will you be staying at the Radisson Resort at the Port
 Yes  No
 

I will be attending
 M  Tu  W  Th  All
 

How did you hear about the conference?
 Colleague
 EMail Notification
 Past Attendee
 USACA Website
 Other

Registration:  $500 before 11/16/2012, $550 from 11/17/2012 until the conference



Exhibitor Information - SOLD OUT


I want to exhibit ($625)
 Exhibitor Fee $625 (0)
Exhibitor Items
 5amp $15.00
 10amp $20.00
 20amp $25.00
Company Exhibitor Profile Statement (up to 10 lines)
Shipping Directly to Conference Site
 Yes
 No
Exhibit Booth Preference

Sponsorship Information


Sponsor Options
 Refreshment Morning Break Sponsorship $400 each (4 available) (4)
 Refreshment Afternoon Break Sponsorship $400 each (4 available) (4)
 Continental Breakfast Sponsorship $600 each (4available) (4)
 Lanyard Sponsor $1500.00 (0)
Please upload your logo for Sponsorship Materials

Payment Information

If you have selected "Payment by Check, Purchase Order or Onsite," please leave the credit card fields blank.


Method of Payment

Credit card information:

Card Type
Name on Card
Credit Card Number
CVV (located on back of card)
Expires

For Internal Use Only


Verified
Notes