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:     *    *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:

   2.Second Person from Dealership (Company)
Qty.
Total
 Badge Name:
$295
$
 Email Address:
 
 Check One:

   3.Third and Additional Person(s)
Qty.
Total
 Badge Name:
$195
$
 Email Address:
Per Person
 Check One:
         
 Badge Name:
     
 Email Address:
     
 Check One:
         
 Badge Name:
     
 Email Address:
     
 Check One:
 
 Badge Name:
     
 Email Address:
     
 Check One:
 

  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.