2010 Conference-Individual Registration Form - United States Indoor Sports Association

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Individual Registration

PRE-REGISTRATION HAS CLOSED. PLEASE COMPLETE, PRINT AND PRESENT THIS FORM FOR ON-SITE REGISTRATION AND CHECK-IN.

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* = required field

Business/Facility Name:

Billing First Name:*

Billing Last Name:*

Badge Name (if other than above)

Title:

Telephone:*

Evening: Fax:

Email Address:*

Website:

USIndoor Member:*

Startup:*

Total Registrations:*

Become a USIndoor Facility Member.

2010 Registration Rates	USIndoor Member	Non-Member
Until May 1
1st or 2nd attendee 3rd attendee or more	$275 $150	$375 ---
Until June 11
1st or 2nd attendee 3rd attendee or more	$325 $195	$475 ---
After June 11 (on-site)
1st or 2nd attendee 3rd attendee or more	$395 ---	$550 ---

All Registrants' Badge Names:

(IMPORTANT: Identify any existing CAO with "*" to ensure CEU credit.)

Additional Programing Rates Conference registration is not a prerequisite for additional programs.		Attendees
Certified Arena Operator Class Wed., 6/16 - Thurs. 6/17, All Day
Until May 1	$495
Until June 11	$595
After June 11 (on-site)	$695
Attendee Name(s):

Facility Bus Tour (note conflict with CAO Class)
Reservations after 5/25 will be placed on a Wait List.
Thursday, 6/17, All Day	$
Attendee Name(s):

World Cup Celebration
Sat., 6/19, Dinner & Entertainment	$
Attendee Name(s):

Referee Certification (minimum of 15 pre-registrations required)
Referee Certification is no longer available.
Sun., 6/20, All Day	$
Attendee Name(s):

Please check if you do not wish for your company or name to appear in USIndoor's Directory.

Please indicate your personal specialty if any:

For other:

Total Registration: $

Billing Information:
Address:*
City:*	State/Province:*
Postal Code:*	Country:
NOTE: To complete your online registration, click "Submit" and follow the instructions to pay by credit card. To register by mail, click "Print," and mail your completed form, along with a check made payable to "USINDOOR" in the amount above, to the following address: 1340 N. Great Neck Road, Suite 1272-142. For on-site registration, click "Print" and present your completed form, along with payment, upon check-in. No refunds after May 1. In case of questions call USIndoor at 703-820-2810. Thank you.

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United States Indoor Sports Association,
1340 N. Great Neck Road, Suite 1272-142 | Virginia Beach, VA 23454-2268
Fax: (509) 357-7096 | Email: pr@usindoor.com
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