InterActivity 2017 Registration Form
Contact Information
Full Name (as you would like printed on your name badge)
Organization
Title
Phone
Email
Address
City
State/Province
Zip
Country
First-in-Line
Early Bird
Advance
Onsite
(Oct 12–Nov 2)
(Nov 3–Jan 18)
(Jan 19–April 5)
(April 6–May 5)
Conference Registration
Full Conference: May 2-5
U.S. Member
$525
$550
$600
$650
U.S. Nonmember
$625
$650
$700
$750
International Member
$525
$550
$550
$550
International Nonmember
$625
$650
$650
$650
Full-Time Student
$250
$250
$275
$300
One-Day Options: May 3, May 4, or May 5
May 3  May 4  May 5
Early Bird
Advance
Onsite
(Nov 3–Jan 18)
(Jan 19–April 5)
(April 6–May 5)
U.S. Member
$300
$350
$380
U.S. Nonmember
$400
$470
$510
International Member
$300
$300
$300
International Nonmember
$400
$400
$400
Full-Time Student
$125
$150
$165
Conference Registration Subtotal: $
Registration Add-On Options
Emerging Museums Pre-Conference: May 2
ACM Member
$225
Nonmember
$325
Ticketed Events
May 2: Museum CEO and Executive Directors Forum
$50
May 3: Museum CEO & Trustee Reception
$40
+ Guest(s)
May 4: Evening Event at Kidspace Children's Museum
$50
+ Guest(s)
Study Tours
May 2: California Science Center
$35
May 3: Noah's Ark at the Skirball Cultural Center
$35
May 3; Kidspace Children's Museum
$35
May 4: The Children's Center at Caltech and Child Educational Center
$35
May 4: NASA's Jet Propulsion Laboratory
$35
Spouses and partners of registered attendees are required to purchase a ticket to attend evening events.
Registration Add-On Subtotal: $
Grand Total: $
Payment Information: Full payment is required with this form.
I have read and agree to abide by the InterActivity 2017 Registration Policies and authorize payment
as listed below.
 Enclosed is my check payable to Association of Children’s Museums.
 Wire Transfer (attach bank confirmation)
Please charge my:
Visa
MasterCard
Card Number:
Expiration Date:
American Express
Discover
Security Code:
Billing Zip Code:
Name on Card:
Special Needs and Requests
 Vegetarian, vegan, or gluten-free meals, please specify:
 Accessibility needs, please specify:
ACM will include the name, title, institution, and email of all registrants in an InterActivity 2017 Attendee List.
To facilitate networking and marketing, the list will be distributed to all registrants and MarketPlace exhibitors
 I agree - include me in the list.
 I do not wish to be included.
Return completed registration form with payment:
Fax: 703.224.3099
Email: [email protected] Mail: Association of Children’s Museums, 2711 Jefferson Davis Highway, Suite 600,
Arlington, VA 22202