AFTA 2017
ANNUAL MEETING and OPEN CONFERENCE
May 31 - June 3, 2017
REGISTRATION FORM - TWO PAGES
NAME: New Member?
(as you want it to appear on your name badge-print clearly please!)
ADDRESS:
DAY PHONE: EMAIL:
FEES: (U.S. Funds Only)
1. Registration:
After
Early 5/8
AFTA Member $445 $495
AFTA Early Career Member $375 $395
AFTA Student Member $350 $375
Non-Member $545 $560
Non-Member Student $350 $375
Student Scholarship $150 $175
One-Day Registration (specify day): $195 $195
Spouse/Partner (Plenaries only) $230
Name of Partner: $
2. Welcome Reception, Wednesday, May 31 No Fee w/ full registration Yes/No
3. New Members Breakfast, Thursday, June 1 No Fee w/ full registration Yes/No
4. Special Events on Thursday, June 1 - Pre-Registration Required
Special Event I: Mural Tour $40 $
Box Lunch w/ tour? $20 $
Special Event II: Dinner and Talent Show $50 $
5. Student / Early Career Lunch, Friday, June 2 No Fee w/ full registration Yes/No
6. Saturday Box Lunch at Town Hall Meeting, Saturday, June 3 $20 $
7. Awards Ceremony & Dinner, Saturday, June 3 No Fee w/ full registration Yes/No
Guest Tickets $90 x $
Fundraiser for AFTA
AFTA Mug $10 $
AFTA Philadelphia T-Shirt Size? ___ S ___ M ___ L ___ XL $25 $
TOTAL AMOUNT ENCLOSED/TO BE CHARGED: $
PAYMENT METHOD: (U.S. Funds Only)
BY CHECK CANCELLATION DEADLINE
BY CREDIT CARD: (Visa/MasterCard ONLY) $50 processing fee for cancellations before May 8, 2017, and 50% refund ONLY after May 8, 2017
Card # Exp. Date: CVV:
Your Signature:
AFTA, 150 Summer St., Haverhill, MA 01830; Fax: (978) 914-7033; Phone: (978) 914-6374
Any dietary restrictions?
Any other special needs?
SESSION REGISTRATION - Required for registration completion
Refer to AFTA Program for Session Details, Select one for each blank
Wednesday, May 31:
1. Network Conversations I, 11:00 AM-12:30 PM:
People of Color OR Conversation on White Privilege
2. LGBTQI Network Conversations II, 1:00-2:30 PM:
3. Member Dialogue, 3:00-6:00 PM
4. Round Table Conversations, 7:30 - 9:30 PM
Thursday, June 1:
5. CS-101 - CS-103, IG-101 - IG-110, 10:45 AM-12:15 PM
6. Dialogue for All, 3:00-6:00 PM
Friday, June 2:
7. CS-201 - CS-213, 10:45 AM-12:15 PM
8. Institutes, 7:30-9:30 PM, Women or Men:
Saturday, June 3:
9. CS-301 - CS-310, 10:45 AM-12:15 PM
10. Town Hall Meeting, 12:30-1:30 PM
11. CS-401 - CS-409, IG-111, 2:00-3:30 PM
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