2017 NAWDP ANNUAL CONFERENCE REGISTRATION
First Name ___________________________________________Last Name________________________________________________
Organization_____________________________________________________Title:_________________________________________
Address: _____________________________________________________________________________________________________
City/State/Zip__________________________________________________________________________________________________
Phone______________________________________ Email of registrant_________________________________________________
Please identify any special needs you have that require assistance (Vegetarian, Vegan, Gluten Free, Mobility, Vision, Hearing, etc):
_____________________________________________________________________________________________________________
Are you a NAWDP Member?  Yes (Membership # _________________________)
Registration Fee (includes all meal functions)
Early Bird
(Payment received March 22, 2017)
__NAWDP Member $445
__New or Renewing NAWDP Member* $520
__Non Member $595
Regular
(Payment received by April 12, 2017)
__NAWDP Member $525
__New or Renewing NAWDP Member* $600
__ Non Member $655
Late Registration
(Payment received after April 12, 2017)
__NAWDP Member $555
__New or Renewing NAWDP Member* $620
__ Non Member $675
* This option includes 1 year membership in NAWDP
Preconference Sessions (May 22th at 8:00am-noon) – $150 Additional fee. SELECT ONLY ONE
___ The Revolutionary New Captain and Coach Approach to Case Management with Larry Robbin
___Data Driven Workforce Development: How LMI Can Guide Investment and Strategy with Greg Wilson
Pre-registrations will be accepted until May 13, 2017. After May 13th, registrations must be made onsite.
Payment Information
□ Check Enclosed
□ Purchase Order (No registrations will be processed until full payment is received for the Purchase Order)
□ Credit Card: (VISA, MasterCard, AMEX) Account Number: __________________________________________________________
Expiration___________ Name on Card____________________________________________________________________________
Cardholder’s Signature_____________________________________ Phone (if different than registrant)_____________________________
Cancellation Policy: Please Read Carefully!
A $75 cancellation fee will be charged for any registrations cancelled before 5:00 pm ET on April 12, 2017. After that date, no
refunds will be provided, except for documented cases of medical emergencies. Substitutions may be made at any time at no cost,
but non-NAWDP members must pay the difference if replacing a member. Cancellations or changes must be provided in writing.
Register online at www.nawdp.org or send registration with payment to:
NAWDP  Attn: Conference Registrations  1155 15th Street, NW – Suite 350  Washington, DC 20005
Fax:
202.589.1799
Questions: 202.589.1790