Registration Form

Renew or sign up for NAMAC membership NOW to get member discounts!

Registration includes: Conference Pass, Opening Reception, Continental Breakfasts, Thursday's Lunch, and Friday afternoon Tours.

Are you a NAMAC Member?*
Yes No

Are you a attending this conference for the first time?
Yes No

First Name:

Last Name:

Title:

Email Address:

Organization:

Mailing Address:

City:

State:

Zipcode:

Telephone Number:

Fax Number:

Website:

I have the following diet restrictions:

I require the following special needs under the American Disabilities Act:

I heard about this conference through:
Email from Scribe Video Center Email from NAMAC Postcard Mailing Poster Conference Website Other Publications NAMAC Website

I am attending the conference primarily as a:
Panelist
Media Artist
Media Center Staff / Board
Funder
Programmer
Distributor
Educator
Activist
Student
Youth (age 16-21)
Press
Other

Please check all that apply

I will attend the Opening Reception on Wed Sept. 28
I would like to attend the Curator's Slam on Fri. Sept. 30
I want to participate in a Show n' Tell or Speed Geeking Session
(Conference organizers will follow up with details following receipt of your registration)
I would like to participate in Animated Conversation Dinner on Fri. Sept. 30
I would like to attend the Closing Event & Awards Ceremony on Sat. Oct.1 - $50, $25 (youth)
I want to participate in Show n' Tell
I want to participate in a Friday Tour

I will be paying using the following method:
Visa, Mastercard, Amex, or Paypal
Check