AASC Conference Registration and Membership Dues Form Name First: Last: Contact Info Email: Phone: Address Street 1: Street 2: City: State: None AL AK AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC NE NH NJ NM NV NY ND OH OK OR PA RI SC SD TN TX UT VT VA WA WI WV WY Zip: Organization AASC Conference Ticket Includes one ticket each to the Banquet and Awards Luncheon ($315) ACIS Workshop Registration for full-day ACIS Workshop prior to AASC Meeting ($35) Kickoff Icebreaker Will you attend Kickoff Icebreaker the evening before the AASC Meeting begins? (No additional cost) Yes No Additional guests for Icebreaker 0 1 2 3 4 5 AASC Membership Dues None SC and RCC Director Dues $100.00 Associate Dues $40.00 Awards Luncheon Additional Guest Ticket(s) - $ each 0 1 2 3 4 5 AASC Banquet Additional Guest Ticket(s) - $ each 0 1 2 3 4 5 Allergies / Dietary Restrictions Please note any allergies, or dietary restrictions you or your guest(s) may have. Evening Event Are you interested in attending one of these offsite events on Wednesday evening? (Separate costs apply; payable at event.) Bowling Social Event(TBA) Neither Additional guests for evening event(s) 0 1 2 3 4 5 Subtotal: Processing Fee: Total Cost: Code: Discount applied upon checkout.