55th Annual IRWA Region 2 - Seminar – August 3-4, 2017
Sleeping Rooms -- Hilton Hotel & Conference Center - 801 University Drive East –
College Station, TX 77840 - (979) 693-7500 ph.
Please print clearly.
First Name: Last Name: ______
Nametag/Nickname: Chapter #______SR/WA Yes ______No ______
Agency/Company:
Address:
City: State: Zip:
Phone: Fax: E-Mail:
Designations: __R/W-AC, __R/W-AMC, __R/W-EC, __R/W-NAC, __R/W-RAC, __R/W-UAC
REGISTRATION FEE
Includes: reception Wed. night, continental breakfast and breaks on Thurs, awards lunch on Thurs, continental breakfast and breaks on Fri, Audio Visual equipment and support and admittance into all meetings unless otherwise noted in the agenda.
o Early Registration Fee (Thru July 20, 2017) $225 o Late Registration Fee $275 (after July 20, 2017)
No Refunds After July 12, 2016, Substitutions Are Encouraged, All Refunds Incur $25 Processing Fee
o Extra Award Lunch Tickets for Guests $55 x ______(ALL PARKING IS SELF PARKING)
PAYMENT INFORMATION - (Housman & Associates Tax ID# 20-0895486) Make Checks Payable to Housman and Associates
Check Number: o Visa o Discover o MasterCard o American Express
For TxDOT Employees: Card Number:______
Finance Rep:______Expiration Date:
Housman and Associates will invoice thru Security Code:______
Texas DOT Financial Rep Name on Card: ______
Full Address CC bill comes to:______
Total Registration Fees: $ ______
For payment by check or
TxDOT Rep
Make checks payable to Housman and Associates
Mail completed form to:
Housman & Associates
1309 Pasa Tiempo
Leander, TX 78641
For credit card payment ONLY
Fax completed form to:
Housman & Associates
(512) 259-5571