2016 ANNUAL MEETING REGISTRATION FORM
SIGMA 3930 Pender Drive, Suite 340 Fairfax, VA 22030 Fax: 703-709-7007 Email: [email protected]
2016 ANNUAL MEETING REGISTRATION FORM Please complete this form (using a separate form for each registrant from your company), and return it to the address above. BADGE INFORMATION Full Name: Title: Nickname (for badge): Company: Short Company Name: (for badge, 15 characters max.): Address: City:
State:
Phone:
Email:
Zip:
CANCELLATION POLICY
ATTENDING SPOUSE/GUEST BADGE INFORMATION
All cancellations requests must be made in writing to [email protected]. Requests received before July 30, 2016 will receive a full refund. Requests received before September 15, 2016 will receive a 50% refund. Refunds will not be issued after September 15, 2016.
Full Name: Nickname (for badge): Spouse/Guest Email: Address: City:
State:
Zip:
Phone:
REGISTRATION FEES Here and Now Rates Until November 30
Early Bird Rates Until June 30
Regular Rates Until September 15
$620
$850
$950
$1,050
$
$250
$250
$350
$400
$
Non-Fuel Supplier Rate
$1,099
$1,199
$1,299
$1,399
$
Non-Member Rate
$2,995
$2,995
$2,995
$2,995
$
BEST RATE
SIGMA Member Rate
Spouse/Guest Rate
Late/Onsite Rates After September 15
Total Amount Due:
Amount Due
$
PAYMENT INFORMATION Check Enclosed
Credit Card:
Credit Card Number:
Expiration Date:
Name on Card:
Signature:
Visa
MasterCard
BOOSTER SIGNATURE I understand that $10 of my meeting registration fee, which cannot be deducted from the total, covers my dues as a SIGMA Booster. Signature:
Date:
American Express
2016 ANNUAL MEETING REGISTRATION FORM Please complete this form (using a separate form for each registrant from your company), and return it to the address above. BADGE INFORMATION Full Name: Title: Nickname (for badge): Company: Short Company Name: (for badge, 15 characters max.): Address: City:
State:
Phone:
Email:
Zip:
CANCELLATION POLICY
ATTENDING SPOUSE/GUEST BADGE INFORMATION
All cancellations requests must be made in writing to [email protected]. Requests received before July 30, 2016 will receive a full refund. Requests received before September 15, 2016 will receive a 50% refund. Refunds will not be issued after September 15, 2016.
Full Name: Nickname (for badge): Spouse/Guest Email: Address: City:
State:
Zip:
Phone:
REGISTRATION FEES Here and Now Rates Until November 30
Early Bird Rates Until June 30
Regular Rates Until September 15
$620
$850
$950
$1,050
$
$250
$250
$350
$400
$
Non-Fuel Supplier Rate
$1,099
$1,199
$1,299
$1,399
$
Non-Member Rate
$2,995
$2,995
$2,995
$2,995
$
BEST RATE
SIGMA Member Rate
Spouse/Guest Rate
Late/Onsite Rates After September 15
Total Amount Due:
Amount Due
$
PAYMENT INFORMATION Check Enclosed
Credit Card:
Credit Card Number:
Expiration Date:
Name on Card:
Signature:
Visa
MasterCard
BOOSTER SIGNATURE I understand that $10 of my meeting registration fee, which cannot be deducted from the total, covers my dues as a SIGMA Booster. Signature:
Date:
American Express
