ATTENDEE REGISTRATION FORM
*This form is for Convention Attendees only. If you are an Exhibitor, please do not use this form. Contact Kim Cook to register.
*Contact Name
*Company:
NIADA Member #:      (if known)		REGISTER NOW & SAVE $100!! Pre-registered and save $100 for a full convention registration. Hurry, offer expires June 11, 2010.
*Mailing Address:
*City:     * Choose a state Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. West Virginia Wisconsin Wyoming    *Zip Code:
*Telephone Number:     Fax Number:
*Email Address: Website Address:
Is this your first time to attend a NIADA Convention & Expo? Yes or No
Do you plan to make reservations at the Caesars Palace Hotel ? Yes or No
Check All That Apply: NIADA Member Retail Dealer BHPH Dealer   Independent Dealer Franchise Dealer
All attendees must be registered. No admittance to any event without a badge. If you require a special diet, please contact NIADA
Register Now!! All prices will increase onsite.  Convention Registration - Access to all events        1.First Person from Dealership (Company) Qty. Total  Badge Name: $395 $  Email Address:    Check One: Dealer/Corporate Officer F&I Manager General Manager Other Employee    2.Second Person from Dealership (Company) Qty. Total  Badge Name: $295 $  Email Address:    Check One: Dealer/Corporate Officer F&I Manager General Manager Other Employee    3.Third and Additional Person(s) Qty. Total  Badge Name: $195 $  Email Address: Per Person  Check One: Dealer/Corporate Officer F&I Manager General Manager Other Employee            Badge Name:        Email Address:        Check One: Dealer/Corporate Officer F&I Manager General Manager Other Employee            Badge Name:        Email Address:        Check One: Dealer/Corporate Officer F&I Manager General Manager Other Employee    Badge Name:        Email Address:        Check One: Dealer/Corporate Officer F&I Manager General Manager Other Employee     4.Children ages 13 yrs old - 17 yrs old (age 12 and under are free) Qty. Total  Badge Name: Age: $  125 $  Badge Name: Age: Per Child      Badge Name: Age:         Expo Only Registration Access To Exhibit hall ONLY...June 15th - 17th.               Qty. Total  Badge Name: $225 $  Title: Per Person      Email Address:          Badge Name:        Title:        Email Address:              Badge Name:        Title:        Email Address:              Badge Name:        Title:        Email Address:                 TOTAL AMOUNT DUE           $

In the event of cancellation, Written Notice must be received by May 28, 2010 for a full refund
minus a $25 cancellation fee. Refunds will be in the same manner as payment received. No refund will be given for cancellations received after June 1, 2010.