WORK EXCHANGE 2011 GAS Conference Registration / Membership Form
San Jose, CA June5-7, 2015–Interface: Glass, Art, and Technology
Register by March 1st for the lowest rate!
Registration NOT accepted via telephone
Confirmation & Cancellation info: / QUESTIONS
T: 206-382-1305Mon-Fri 9-5 PST / OFFICE USE ONLY: DATE
TOTAL $ MEMB
CHK/APPR REG
1. PERSONAL DATA PRINT LEGIBLY
First & Last Name / Please mark all that apply to you:
[ ] Artist (sub-categories)__commissions __beadmaking __architectural/public art
__casting __coldwork/engraving __flameworking __fusing/slumping __glassblower
__kilnforming __leaded/stained __neon __painting __other
[ ] Manufacturer/Supplier(sub-categories) __ mosaic/stained glass tools/supplies
__casting tools/supplies __coldworking tools/supplies __kilnforming tools/supplies
__flameworking tools/supplies __furnaces/annealers __hot glass tools/supplies
[ ] Educator (types of classes you teach) __undergraduate/graduate __studio workshops/classes
__highschool/youth classes __summer program
[ ] School (classes your school/studio offers) __undergraduate/graduate __studio workshops/classes
__highschool/youth classes __summer program
[ ] Collector [ ] Museum [ ] Gallery Owner [ ] Hotshop Owner [ ] Press/Critic
Company
Address
City / State / Zip/Postal
Country / Tel:
Website
[ ] Omit my contact information from online Membership Directory
[ ] Omit my contact information from the sale of mailing lists.
2. GAS MEMBERSHIP / CONTRIBUTIONS Must be current member through June 2015 to attend the conference.
[ ]My GAS membership is current through June2015(to be confirmed by GAS Staff).
[ ]I would like toJoin/Renew my membership at the level checked below:
___$70USD Individual
___$40USD Full-time Student*Student ID or other proof required:
SCHOOL ATTENDING ______
Upper Level Memberships can have two members. Please list the
2nd Member & their email. ______
___$120USD Sponsor
___$275USD Corporate/Business
___$500USD Patron
___$1,000USD Benefactor / Make a Contribution: Full list & descriptions
$______Becky Winship Flameworking Scholarship Fund
$______Dominic Labino Lecture Fund
$______GAS Fund in CERF
$______General Scholarship Fund
$______Hilbert Sosin Fund for Professionalism
$______Robert Willson Lecture Fund
$______Sy Kamens Education Fund
$______Unrestricted General Contribution
$______Other (Fund Name) ______
$______GAS MEMBERSHIP & CONTRIBUTIONS SUBTOTAL
3. CONFERENCE REGISTRATION Must be a current GAS member through June 2015 to register and attend, see step 2.
FULL CONFERENCE PASS
Includes all lectures; panels; demonstrations; Opening Ceremony & Reception; Closing Night Party, Gallery Hop, & other events during the conference EXCEPT special events & tours with additional fees.
Early Bird Pre-Registration: December 1, 2014 – March1, 2015
#__$165 USD per Full-time Student* member (ID or other proof required)
#__$295 USD per Individual member
[ ] Corporate Member Discount: $221 (25% off 1 pass)
[ ] Patron Member Discount: $148 (50% off 1 pass)
[ ] Benefactor Member Benefit: $0 (1 free pass)
Pre-Registration: March 2, 2015–May 25, 2015
#__$195 USD per Full-time Student* member (ID or other proof required)
#__$350 USD per Individual member
[ ] Corporate Member Discount: $263 (25% off 1 pass)
[ ] Patron Member Discount: $176 (50% off 1 pass)
[ ] Benefactor Member Benefit: $0 (1 free pass) / DAY PASSES TO THE CONFERENCE
For those wishing to attend only 1 or 2 days. Includes lectures, panels, demos, and other events ONLY taking place on the day or days for which you register EXCEPT special events and tours with additional fees.
#__$95 USD per Full-time Student* member / per day
#__$170 USD per Individual member / per day
Circle day or days attending: FRIDAY SATURDAY SUNDAY
PLEASE NOTE:We are unable to process registration forms received in the GAS office after May 25, 2015. After May25, register on-site for Full Conference Pass at $395 USD per member / $250 USD per Full-Time Student member*. Day Pass fees do not change.
$______CONFERENCE REGISTRATION FEES SUBTOTAL
4. CLOSING NIGHT PARTY TICKET
A full conference pass or Sunday day pass includes entrance to the Closing Night Party to be held at BAGI on Sunday, June 7 from 7pm-10pm.
For guests of conference attendees who are not registered for the conference, or Friday or Saturday day pass conference registrants, you may wish to purchase a ticket to this fun filled event.This event is not open to the general public.
#___ $40 USD for Guests of conference attendees-or-those registered with a Friday or Saturday Day Pass
$______CLOSING NIGHT PARTY TICKET SUBTOTAL
5. COLLECTORS TOUR - Wednesday, June 3 to Sunday, June 7, 2015
Tour price includes:a full conference pass, admission fees & ground transportation to all tour events, most lunches and dinners, and VIP seating for special events. Be treated to a unique glass focused experience in both San Francisco and San Jose, CA.Minimum 15 / Maximum 25 participants.
#___ $1,325 USD Collectors Tour (San Francisco & San Jose): MEMBER
#___ $1,425 USD Collectors Tour (San Francisco & San Jose): NON-MEMBER
$______COLLECTORS TOUR SUBTOTAL
TOTAL TO BE CHARGED OR CHECK ENCLOSED
$______GAS MEMBERSHIP & CONTRIBUTIONS SUBTOTAL
$______CONFERENCE REGISTRATION FEES SUBTOTAL
$______CLOSING NIGHT PARTY TICKET SUBTOTAL
+$ COLLECTORS TOUR SUBTOTAL
$______TOTAL AMOUNT(sum of sections 2-5 above. All fees in USdollars)
PAYMENT INFORMATION
Preferred method of payment is by credit card to give you the best exchange rate.
Payment must be made to the Seattle GAS office in US dollars and will appear on your credit card statement in your own currency.
[]Visa or Master Card: # _ _ _ _ - _ _ _ _ - _ _ _ _ - _ _ _ _ Expiration Date _ _ / _ _ Signature ______
[]Personal Checkdrawn from a USA bank only. Due to the high cost of processing checks drawn on non-USA banks, we cannot accept them.
Checks must be made out to the “Glass Art Society” for the appropriate amount only.
[]Wire transfer(for instructions, contact the GAS office, additional fees apply)
REGISTRATION AVAILABLE ONLINE -WWW.GLASSART.ORG
MAIL THIS FORM TO: Glass Art Society, 6512 23rd Ave NW, Suite 329, Seattle, WA 98117 USA
FAX THIS FORM TO: 206-382-2630
GAS IS NOT ABLE TO ACCEPT REGISTRATION VIA TELEPHONE
CONFIRMATION
- An email confirmation of your registration will be sent within 2 weeks ofour receipt of your registration form (or to the address provided if no email given).
- Please contact the GAS office if you have not received confirmation within a month of sending your registration.
- Cancellations received in writing before March 1,2015 will receive a full refund.
- Any changes to registration received in writing March 2–May 25, 2015 will be subject to a $35 administrative fee.
- There will be no refunds after May 25, 2015.
Contact r call 206-382-1305, Monday-Friday, 9am - 5pm PST.
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