2019 NAPSEC Annual Leadership Conference Registration Form

2022 NAPSEC Annual Leadership Conference

REGISTRATION FORM

January 16-19, 2022

The Hotel Monteleone
New Orleans, LA

All registrations must be submitted online
Name*

FirstMiddleLast
Email for confirmation and conference news*
Agency/Program
Phone number*

Area CodePhone Number
Are you a first time attendee?

YesNo
Would you like a mentor during the conference?

YesNo
Please indicate any food allergies or special diet requests*
Conference Photo Release Acceptance*

NAPSEC will take photos of attendees throughout the conference. These photos are for NAPSEC use only and may appear on the NAPSEC website, newsletter, conference brochures, social media outlets, or other future NAPSEC promotional material. By virtue of your attendance, you agree to usage of your likeness in such media.
Conference COVID-19 Policy Acceptance *

I understand NAPSEC will implement protocols appropriate to the public health circumstances existing at the time of the 2022 Annual Leadership Conference in order to ensure the health and safety of those participating and also that of the vulnerable populations NAPSEC members serve. Those protocols will include, but are not limited to, the following:
- Proof of full vaccination status and/or proof of a negative COVID-19 test within 72 hours are required for all conference participants.
- Mask-wearing requirements will align with local regulations for indoor space. Currently, masks are required for indoor events regardless of vaccination status.
The health and safety of all visitors to NAPSEC conferences remains our top priority. We are closely monitoring government mandates and policy changes, Centers for Disease Control and Prevention (CDC) guidelines and public health advancements. As information pertaining to the virus continues to develop, we will adjust our approach as needed and keep you up to date with new developments to ensure a coordinated effort and a safe environment for all conference attendees. Please take a moment to review important conference requirements, local regulations, safety measures, and policies on our conference website.
We strongly encourage you to upload a copy of your vaccination card in advance of the conference. This will make your registration faster and easier. You may also bring your vaccination card or proof of negative test result onsite for verification. Please note we are unable to make any exceptions to this policy.

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Please complete and submit your online registration below, and send payment to: Danielle Johnson NAPSEC 200 Massachusetts Ave NW Suite 700 Washington, DC 20001
NAPSEC Annual Leadership Conference Registration

NAPSEC Member Registration - $675NAPSEC Member Registration - $500 - First time conference attendee /additional attendee from member program/retiree from NAPSEC program.Non-Member Registration - $775Tricky Tray Raffle Voluntary Contribution - $100 Please add a voluntary contribution of $100 to my registration fee to support the Tricky Tray Raffle and the NAPSEC FoundationRich Robinson Memorial Golf Classic - $100 (1 Golfer) - (indicate golfer's name below) - Tuesday, January 17th (green fees, lunch, and (2) alcoholic beverages included).Rich Robinson Memorial Golf Classic - $200 (2 Golfers) - (indicate golfer's name below) - Tuesday, January 17th (green fees, lunch, and (2) alcoholic beverages included).Full Guest Registration Fee - $300 (indicate guest's name below) - Guest options are only for family and/or friends who come to the conference with an attendee. The Full Guest Fee includes (3) breakfasts, (3) breaks and a conference program and participation in the Welcome Reception, NAPSEC Wine Tasting & Exhibitor Showcase, and the Awards Luncheon.Guest Fee - $65.00 - (indicate guest's name below) – Welcome Reception (Sunday evening)Guest Fee - $55.00 - (indicate guest's name below) – NAPSEC Wine Tasting & Exhibitor Showcase (Monday evening)Guest Fee - $60.00 - (indicate guest's name below) – Awards Luncheon (Wednesday)
Total
REGISTRATION FEES

NAPSEC Annual Leadership Conference Registration

NAPSEC Member Early Bird Registration - Registration before November 19, 2021$675.00

NAPSEC Member Registration - First time conference attendee /additional attendee from member program/retiree from NAPSEC program.$500.00

Non-Member Early Bird Registration - Registration before November 19, 2021$775.00

Tricky Tray Raffle Voluntary Contribution - Please add a voluntary contribution of $100 to my registration fee to support the NAPSEC Foundation$100.00

Rich Robinson Memorial Golf Classic (indicate golfer's name below) - Tuesday, January 21st (11:30 AM - 5:30PM) Green fees, lunch, (2) alcoholic beverages and a goodie bag are included. $100.00

Quantity

Full Guest Registration Fee (indicate guest's name below) - Guest options are only for family and/or friends who come to the conference with an attendee. The Full Guest Fee includes (3) breakfasts, (3) breaks and a conference program and participation in the Welcome Reception, NAPSEC Happy Hour & Exhibitor Showcase, and the Awards Luncheon.$300.00

Guest Fee (indicate guest's name below) – Welcome Reception.$65.00

Guest Fee (indicate guest's name below) – NAPSEC Happy Hour & Exhibitor Showcase.$55.00

Guest Fee (indicate guest's name below) – Awards Luncheon.$60.00

Total $0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Rich Robinson Memorial Golf Classic
Golfer (1) Name

First NameLast Name
Golfer (1) handicap/average shot/18 holes
Golfer (1) Renting Clubs

YesNo
Golfer (2) Name

First NameLast Name
Golfer (2) handicap/average shot/18 holes
Golfer (2) Renting Clubs

YesNo
GUEST REGISTRATION
Guest Name
Please indicate any food allergies or special diet requests
Selections:

Full Guest Fee $300Welcome Reception - January 16th $65NAPSEC Happy Hour & Exhibitor Wine Tasting - January 17th $55Awards Luncheon - January 19th $60
THANK YOU FOR YOUR REGISTRATION!

Cancellations received before December 31, 2021 will be refunded in full less a $25 handling fee. No refunds will be given after December 31, 2021.

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