Last Name

First Name

Home Address (Street)

City State Zip

Home Phone

Cell Phone

Work Address (Street)

City State Zip

Title/Position

Work Phone

Email

Member of PNA Chapter: Yes No

If Yes, Chapter Name:

No Onsite Registration. We encourage participants to pre-register no later than January 20, 2008.

Registration fee is $300.00

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Refund Policy: No telephone cancellation will be accepted. Refund of fees less $50.00 administrative costs if written cancellation received before January 20, 2008. No refunds granted after January 20, 2008.

Registrants:
Send completed registration form print form and mail with check payable to: PNAA
Please send payment to:
PNAA - c/o Merlita Velazquez
6222 Ballina Canyonn Lane
Houston Texas 77041

Information/Questions:
For program inquiries, please contact:
info@pnanewyork.org
pnaapres0608@aol.com