2015 National Conference Delegate Registration
JACKSONVILLE, FL
School Name: _________________________________
 School Advisor: _________________________________
School Address: _________________________________
City: _________________________________
State: _____________________    Zip: ______________
Phone: _____________________  Fax: ______________
Email: _________________________________
Co-op Buyer: _________________________________
Student Activities Board Members  Position
____________________________________ __________________________
____________________________________ __________________________
____________________________________ __________________________
____________________________________ __________________________
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% of Budget spent on: Comedy: ____% Lectures: ____% Movies: ____%
  Music: ____% Novelties: ____% Other: ____%
Student Population Demographics
   __ BELOW 3,000 Public:__  Private:__ 
   __ 3,000 – 5000 Commuter: __
   __ 5,000 - 10,000 4-year: __ 2-year: __
   __ 10,000 -15,000 Tech/Trade: __
   __ 15,000 - UP Activities Budget: $ __________
Names of Delegates Attending APCA National Conference (list additional delegates separately):    .

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Delegate Fee Schedule
Spouse or Domestic Partner $129.
Can not be employee or student representing interests of attending organization.
REVIEW CAREFULLY TO AVOID MISCALCULATION OF FEES!

Prior to 2/13/15

Member

Non-Member

Day Pass (member)

Day Pass (non-member)

1-5 delegates

$239 / delegate

$279 / delegate

$169/ delegate

$179 / delegate

6+ delegates

$229 / delegate

$269 / delegate

$159 / delegate

$169 / delegate

After 2/13/15

Member

Non-Member

Day Pass (member)

Day Pass (non-member)

1-5 delegates

$259 / delegate

$299 / delegate

$175 / delegate

$195 / delegate

6+ delegates

$249 / delegate

$289 / delegate

$165 / delegate

$185 / delegate

Spousal Fee: $129
Military Rate: $159

Delegate fees include:
3 Dinners
50+ Educational Sessions
100+ Live Showcases and Expo Access
Conference t-shirt, gift, and much more!

*Delegate fees are nonrefundable, but a $75 credit per cancelled delegate towards your choice of another APCA conference is allowable in event of cancellations (good for one year from ending date of cancelled conference).
T-Shirts: Each delegate registering gets a t-shirt. Please indicate the total # of shirts need for each size.

___SM      ____MED     ___LG      ____XL     _____XXL    
Total Delegate fees enclosed (see above) $______
Spousal fees enclosed for __ number of spouses/domestic partners @ $129 ea. $______
____  Institutional membership fees enclosed ($299 per campus)
_____ We are an APCA Member (membership fees already paid through July 1, 2026 )
Schools registering delegates must be APCA members in good standing or pay nonmember prices.		 $______
TOTAL FEES ENCLOSED or AUTHORIZED TO BE CHARGED
The APCA FEI Number is 650551461		 $

We will require _____ vegetarian meals (If unknown, please contact us at (800) 681-5031 when number is determined.)

Credit Card Orders:
__VISA   __MasterCard  __American Express

Card Number: ________________   Exp. Date: ________

Name on Card: ________________________

CV2 Number:______ (3 digit # on back of card)
 
Signature: __________________________________ Date:___/___/___

Billing Information:
Billing Address: _________________________________________________

Billing City, State: ___________________, ____   Zip: ______________

Signature of Advisor: _________________________ Date:___/___/___
Please Print Advisor´s Name Here: ________________________________
Conference Cooperative Buyer (please print): ______________________________
I have read and agree to abide by the APCA registration and membership policies
as outlined on this web site.

Mail this form with You may fax this form with Credit Card information to 865-908-7104 or mail check payable to APCA to:

APCA, P.O. Box 4340, Sevierville, TN 37862
(800) 681-5031