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. B AD G E I N F O R M AT I O N Full Name: Title: Nickname (for badge): Company: Short Company Name: (for badge, 15 characters max.): Address: City:
State:
Phone:
Email:
Zip:
CANCE L L AT I O N P O L I C Y
AT T E NDI NG S P OUS E /GU EST BAD G E IN FO R MATIO N
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:
R EG IST R AT I O N F E E S Early Bird Rates Until September 15
Regular Rates Until September 15
$850
$950
$995
$
$250
$325
$375
$
Non-Fuel Supplier Rate
$1,199
$1,299
$1,399
$
Non-Member Rate
$2,995
$2,995
$2,995
$
The Kreeger Museum: A Personal Collection Thursday, November 3 • 9:30 AM – 12:30 PM
$40
$40
$50
$
George Washington’s Mt. Vernon Thursday, November 3 • 9:30 AM – 2:30 PM
$95
$95
$105
$
The Phillips Collection Thursday, November 3 • 1:15 PM – 4:15 PM
$45
$45
$55
$
BEST RATE
SIGMA Member Rate
Spouse/Guest Rate
Late/Onsite Rates After September 15
Amount Due
SPECIAL EVENTS
TOTAL AMOUNT DUE:
$
PAYM E N T I N F O R M AT I O N Check Enclosed
Credit Card:
Credit Card Number:
Expiration Date:
Name on Card:
Signature:
Visa
MasterCard
B O O ST E R S I G N AT U R E 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. B AD G E I N F O R M AT I O N Full Name: Title: Nickname (for badge): Company: Short Company Name: (for badge, 15 characters max.): Address: City:
State:
Phone:
Email:
Zip:
CANCE L L AT I O N P O L I C Y
AT T E NDI NG S P OUS E /GU EST BAD G E IN FO R MATIO N
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:
R EG IST R AT I O N F E E S Early Bird Rates Until September 15
Regular Rates Until September 15
$850
$950
$995
$
$250
$325
$375
$
Non-Fuel Supplier Rate
$1,199
$1,299
$1,399
$
Non-Member Rate
$2,995
$2,995
$2,995
$
The Kreeger Museum: A Personal Collection Thursday, November 3 • 9:30 AM – 12:30 PM
$40
$40
$50
$
George Washington’s Mt. Vernon Thursday, November 3 • 9:30 AM – 2:30 PM
$95
$95
$105
$
The Phillips Collection Thursday, November 3 • 1:15 PM – 4:15 PM
$45
$45
$55
$
BEST RATE
SIGMA Member Rate
Spouse/Guest Rate
Late/Onsite Rates After September 15
Amount Due
SPECIAL EVENTS
TOTAL AMOUNT DUE:
$
PAYM E N T I N F O R M AT I O N Check Enclosed
Credit Card:
Credit Card Number:
Expiration Date:
Name on Card:
Signature:
Visa
MasterCard
B O O ST E R S I G N AT U R E 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
