Instructions Nickname (for badge): Fill out this form
Badge Information Full Name: Title: Instructions Fill out this form, using a separate form for each registrant from the company and return form to: SIGMA 3930 Pender Drive Suite 340 Fairfax, VA 22030 Fax: 703-709-7007 Email: [email protected]
Nickname (for badge): Company: Short Company Name: (for badge, maximum 15 characters) Address: City:
State
Zip
State
Zip
Phone: Email:
Cancellation Policy
Attending Spouse/Guest Badge Information
All cancellations requests must be made in writing to [email protected]
Full Name: Nickname (for badge):
Requests received before September 30, 2016 will receive a full refund.
Spouse Email:
Requests received before December 1, 2016 will receive a 50% refund.
Address:
Refunds will not be issued after December 1, 2016
City: Phone:
Registration Fees Early Bird Rates Until September 16
Regular Rates Until November 18
Late/Onsite Rates After November 18
SIGMA Member Rate BEST RATE!
$499
$649
$799
Additional Marketer from Same Company
$449
$599
$749
Non-Member Rate
$3000
Non-Fuel Supplier Rate
$3000
SIGMA Partner Rate
$1000
Spouse/Guest Fee
$149
$199
$249
Family Rate* Spouse/Guest and children under 21
$249
$299
$349
$99 x _________
$109 x ________
$119 x ________
Special Dinner Event Exhibitor Booth
$550 Total Amount Due
Payment Information □ Check Enclosed
□ Credit Card (Visa, MasterCard or American Express only)
Card #:
Expiration Date:
Signature: 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:
Amount Due
Nickname (for badge): Company: Short Company Name: (for badge, maximum 15 characters) Address: City:
State
Zip
State
Zip
Phone: Email:
Cancellation Policy
Attending Spouse/Guest Badge Information
All cancellations requests must be made in writing to [email protected]
Full Name: Nickname (for badge):
Requests received before September 30, 2016 will receive a full refund.
Spouse Email:
Requests received before December 1, 2016 will receive a 50% refund.
Address:
Refunds will not be issued after December 1, 2016
City: Phone:
Registration Fees Early Bird Rates Until September 16
Regular Rates Until November 18
Late/Onsite Rates After November 18
SIGMA Member Rate BEST RATE!
$499
$649
$799
Additional Marketer from Same Company
$449
$599
$749
Non-Member Rate
$3000
Non-Fuel Supplier Rate
$3000
SIGMA Partner Rate
$1000
Spouse/Guest Fee
$149
$199
$249
Family Rate* Spouse/Guest and children under 21
$249
$299
$349
$99 x _________
$109 x ________
$119 x ________
Special Dinner Event Exhibitor Booth
$550 Total Amount Due
Payment Information □ Check Enclosed
□ Credit Card (Visa, MasterCard or American Express only)
Card #:
Expiration Date:
Signature: 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:
Amount Due
