NACA 2017 FCRA Registration Form Page 2 of 2

NACA 2017 FCRA Registration Form Page 2 of 2

Registration Form

PARTICIPANT INFORMATION

Prefix: ______First Name: ______Middle Initial: ______

Last Name: ______Suffix: ______

CONTACT INFORMATION

Title ______

Company Name: ______

Street Address ______

Apt/Suite Number: ______

City: ______State: ______Zip: ______

Phone Number: ______E-mail: ______

  NACA will provide attendees, including exhibitors, with an attendee list onsite that will include organization, city, state, and email. If you do not want to be included on this list, please check the box.

GENERAL ELIGIBLITY REQUIREMENTS

Registrations from nonmembers must be vetted. All nonmember registrations are reviewed to ensure that the registrant does not advocate for lenders, creditors, dealers, businesses, or parties whose interests may be antagonistic to consumers. NACA reserves the right to refuse or cancel all ineligible registrations at any time and shall not be held accountable for any outside fees associated with cancellation. Nonmembers cannot register onsite. If you are a nonmember, please complete the following section and do NOT make your travel plans until your registration has been confirmed.

  I do not advocate for lenders, creditors, dealers, businesses, or other parties whose interests may be antagonistic to consumers.

Please choose one of the following:

  I am in private practice representing consumers

  Legal services or government attorney, or a nonprofit advocate working on behalf of consumers

  Other ______

REGISTRATION QUESTIONS

Please classify your experience level with fair credit cases. Are you a:
Beginner Intermediate Advanced

Do you want vegetarian meals: Yes / No Do you want a kosher meals: Yes / No

  NACA takes photos of all events and will occasionally use group or large crowd photos in promotional materials on the web, social media, and in print. Please check if you do not want your photograph used for future NACA use or distribution. If we ever use a close-up photo of you, we would obtain your permission.

PAYMENT INFORMATION HIGHER LEVEL MEMBERSHIPS

Bronze / Silver / Gold / Platinum
CONFERENCE ONLY
Early-Bird Member Conference Only Prior to 3/17/2017 (includes govt. attorneys) / $569 / $541 / $512 / $427 / $285
Regular/Onsite Member Conference Only After 3/17/2017 (includes govt. attorneys) / $669 / $636 / $602 / $502 / $335
Nonmember Conference Only / $769
CONFERENCE & WORKSHOP
Early-Bird Member Conference + Workshop Prior to 3/17/2017 (includes govt. attorneys) / $825 / $784 / $743 / $619 / $413
Regular Member Conference + Workshop After 3/17/2017 (includes govt. attorneys) / $975 / $927 / $878 / $731 / $488
Nonmember Conference + Workshop / $1175
WORKSHOP ONLY
Member Workshop Only / $375 / $357 / $338 / $281 / $188
Nonmember Workshop Only / $475

NACA provides partial scholarships to attorneys who cannot afford the full registration. Are you interested in making a donation to the scholarship fund? Yes / No If yes, donation amount $______
Total Fee $______Please check method of payment:

  VISA Discover

  MasterCard

  American Express

  Check – Make payable to NACA

National Association of Consumer Advocates
1215 17th Street NW, 5th Floor, Washington, DC 20036
Phone: 202.452.1989 | Fax: 202.452.0099
Email:

NACA 2017 FCRA Registration Form Page 2 of 2

______
Credit Card Number Expiration Date

______
Signature Today’s Date
Refunds are only available in cases of personal or family emergencies. Registrations can be transferred to another NACA member. All cancellations will be charged a cancellation fee. Return this form by fax to 202.452.0099 or by email as a PDF file to . If you are paying by check, mail the form and payment to: Rebecca Smolar, National Association of Consumer Advocates, 1215 17th Street, 5th Fl. Washington, DC 20036.

National Association of Consumer Advocates
1215 17th Street NW, 5th Floor, Washington, DC 20036
Phone: 202.452.1989 | Fax: 202.452.0099
Email: