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 FO R M 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:
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:
Zip:
Nickname (for badge): Spouse/Guest Email: Address: City:
State:
Zip:
Phone:
REGISTRATION FEES Late/Onsite Rates After September 15 BEST RATE
SIGMA Member Rate
Amount Due
$995
$
$375
$
Non-Fuel Supplier Rate
$1,399
$
Non-Member Rate
$2,995
$
The Kreeger Museum: A Personal Collection Thursday, November 3 • 9:30 AM – 12:30 PM
$50
$
George Washington’s Mt. Vernon Thursday, November 3 • 9:30 AM – 2:30 PM
$105
$
The Phillips Collection Thursday, November 3 • 1:15 PM – 4:15 PM
$55
$
Spouse/Guest Rate
SPECIAL EVENTS
TOTAL 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 FO R M 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:
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:
Zip:
Nickname (for badge): Spouse/Guest Email: Address: City:
State:
Zip:
Phone:
REGISTRATION FEES Late/Onsite Rates After September 15 BEST RATE
SIGMA Member Rate
Amount Due
$995
$
$375
$
Non-Fuel Supplier Rate
$1,399
$
Non-Member Rate
$2,995
$
The Kreeger Museum: A Personal Collection Thursday, November 3 • 9:30 AM – 12:30 PM
$50
$
George Washington’s Mt. Vernon Thursday, November 3 • 9:30 AM – 2:30 PM
$105
$
The Phillips Collection Thursday, November 3 • 1:15 PM – 4:15 PM
$55
$
Spouse/Guest Rate
SPECIAL EVENTS
TOTAL 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
