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REGISTRATION FORM Changing Services for Changing Times NJ AER CONFERENCE 8:00-4:00 Monday 11 MAY 2015Circle the amount/category enclosed:Early Bird (extended to April 30, 2015) $50.00 members$85 non-membersAfter April 30, 2015 $85.00 members$120 non-membersDriver/Assistant: $21 Lunch ( if driver/assistant is staying and would like to purchase lunch)Vendor (cost per table):$100 For Profit$60 Non-ProfitName: _________________________________________Address: ________________________________________________________________________________________Phone:___________________________________________E-Mail:____________________________________________Affiliation:__________________________________________AER Member Number: _______________________________Preferred Program Media: (check one) Braille Large Print Regular Print E-Copy (provide E-Address)Send registration to:Sheri Siegel, NJAER Treasurer505 Pomona Ave. Haddonfield, NJ 08033Make Checks Payable to NJ AER |
