Registration for 2012 NETWO
Conference, April 27 - 28
Name
(Please Print) _____________________________________________
Address _______________________________________________________
City ____________________________ State
_______ Zip _____________
Telephone (_____) ______ - ___________
Email
address ___________________________________________________
CONFERENCE REGISTRATION
Friday night
reception, Saturday Program 8:30 – 5:00
By April 2, NETWO
Member $60 Non-member $80 Student
$35 _______
OR
After April
2, NETWO member $75
Non-member $95 Student $45
_______
I’d
like an interview with (circle one): Mary Sue Seymour Weronika
Janczuk Vivian Zabel
Jacque
Graham (see website: www.netwo.org for what these people want.)
Optional
Programs
Friday
Afternoon (1:00 – 5:30) Two (2) Workshops
$35 _________
Awards Banquet - Saturday 5:45 P.M. $15 _________
NETWO
Dues for 2011 – Individual $20; Couple
$25 _________
Total ____________
Method of payment: Check Number ________ or Credit Card
For Credit Card use ONLY
Card
type (circle
one) MC VISA
Card
Number ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Expiration
date Month ____ Year ____ CVC Number ___ ___
___
Name
on Card
______________________________ Signature_________________________
NETWO
P.O. Box 411
Winfield, TX 75493
Click here to return to the registration process.