Category Management Seminar Registration Form

June 3, 2009 to June 4, 2009
Indianapolis, IN

Registration Deadline: May 8, 2009

*Required Fields

Contact Information

Please print your name and address exactly as you wish them to appear on your badge and attendee roster.

*Prefix:

*First Name:

*Last Name:

Suffix:

Nickname for Badge:

*Company:

*Title:

*Address:

*City:

*State / Province:

*Zip / Postal Code:

*Country:

*Phone: Ext.

Fax:

*Email:

*I am a:

Other - Please Specify:

*Is this your permanent address? Yes
No

Hotel Reservations

For this event you must make reservations with the hotel directly.

Reserve a Room Directly with Hotel

Room reservations should be made by contacting the Hyatt Regency Indianapolis directly at (800) 233-1234 . Reference the Category Management Seminar (June) to obtain the group rate of $149 per night, plus 16% tax per room per night. Reservations must be made before May 12, 2009 to get this special rate.

Registration Pricing

*Please choose the level of registration/membership for attendance

NACS Member Price: $695
Regular Price: $895

Credit Card Information

*Credit Card:

*Card Number:

*Card Holder:

*Expiration Date:

Cancellation Policy: Registration cancellations must be sent in writing and faxed to NACS at (703) 684-1610 or e-mailed to aburke@nacsonline.com. All cancellations received on or before May 8, 2009 will be assessed a $25 administrative fee. After May 8, 2009 the full amount of the registration fee will be forfeited. Transfer of registration to another person within your company can be done at anytime without penalty.

The submitter of this form agrees to accept and pay all applicable charges, including adjustments to reflect correction of arithmetical errors as well as all per event costs, based on the events chosen and your company's current membership status with the National Association of Convenience Stores (NACS). Moreover, the submitter specifically authorizes NACS to charge any such amounts to the credit card referenced on this form.