Registration form to be returned to or faxed to (214) 594-5724

Event Pricing
Viewpointe Member: $250
Non-member: $500
Event Registration Information
Name: / Institution:
Title: / Professional Designation: / AAP CTP NCP Other:
Address: / City: / State: / Zip:
Phone: / Email:
My organization is a member of Viewpointe: Yes No Not Sure
Additional Registrations
If you need to register more than three people, you may copy this form.
Name: / Institution:
Title: / Professional Designation: / AAP CTP NCP Other:
Address: / City: / State: / Zip:
Phone: / Email:
Name: / Institution:
Title: / Professional Designation: / AAP CTP NCP Other:
Address: / City: / State: / Zip:
Phone: / Email:
Hotel Information
Hotel accommodations must be made by Sunday, September 8, 2013, separately by calling (800) 950-0086 and asking for the Viewpointe group rate.
Overnight accommodations are available at the Arizona Biltmore – A Waldorf Astoria Resort on Wednesday, October 8 and Thursday, October 9, 2013, for $199 exclusive of applicable state and local taxes, fees and assessments. Reservations must be made before Sunday, September 8, 2013. All rooms must be guaranteed with a one-night deposit. Deposits are fully refundable up to 72 hours prior to arrival date after which they are non-refundable.
Billing and Payment Information
Same as above
Once registration is received, an email confirmation will be sent to each registrant. An invoice will be sent to your organization’s billing contact separately via email. Payment is due within 30 days from the date of the invoice. If payment is not received when due, interest at the rate of 1.5% compounded monthly shall be applied against any then outstanding balance due. In any action for non-payment of amounts due, the prevailing party shall be entitled to recover its reasonable costs, expenses and attorneys’ fees.
Billing Contact Name: / Institution:
Phone: / Fax: / Email:
Please select the payment option you will be using to pay for this registration. Upon receipt of this form, you will receive an email confirmation.
ACH Debit – Member/Individual Account on File
Credit Card – for security, you will be contacted for your card’s information. We accept Visa, MasterCard or Amex.
Check to Viewpointe Clearing, Settlement & Association Services. Remittance invoice will be emailed to your billing contact.
Total # of Member Registrations: / at / $250 / = / $
Total # of Non-member Registrations: / at / $500 / = / $

Cancellation/Substitution Policy: Substitutions are preferred over cancellations, with advance notice. Participants may cancel before Friday, September 27, 2013 to receive a full refund. No refunds will be given after Friday, September 27, 2013 or for no shows. For event/registration questions: Contact Member Services at (800) 279-9059 or .

1999 Bryan Street, Suite 1500, Dallas, TX 75201 - www.viewpointe.com - 1 (800) 279-9059 - - Fax: 1 (214) 594-5724