The NSS Washington Legislative Conference
May 17-18, 2005
Online Conference Registration

If you are an NSS member and the fields below are empty, click Fields marked with a red asterisk * are required. Enter "n/a" for fields that do not apply.

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Section I – Contact Information

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*First Name(s):	*Last Name:
(Please select your Country first.   If not found, select your Continent to bring up list.)
*Country:	United States Australia Brazil Canada China France Germany India Ireland Italy Mexico Japan Russian Federation United Kingdom ------------- North America Caribbean Central America South America Europe Middle East Africa Asia Australia Pacific Antarctica
*Street Address:
*Town/City:	*Postal Code:
*State/Province:	(other) --> Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands (U.S.) Virginia Washington West Virginia Wisconsin Wyoming     Other:
Please provide an email address to receive confirmation of this transaction.
*E-Mail Address:
*Phone Number:	Country Code +
Fax Number:

Membership # (if known):

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Section II – Registration Information

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My Congressman's Name is:
I have attended the Washington Legislative Conference (or a similar event) in the past:	Yes   No
Registration Options: Adult $50 Student (requires valid student ID) $25 Senior (65 or older) $25 Registration Fee: $

   

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