First Name:   Last Name:  

Position:

Affliation/School: 

SAU (if applicable):  

Address, City, State, Zip:  

Phone number: 

E-Mail Address:    

Event Cost:
$125 for NHSDC members (includes lunch)
$150 for non-members (includes lunch and a membership to NHSDC through December 2010)

Payment by Purchase Order
If paying with a purchase order, indicate Purchase Order #:
and complete billing address including city, state, zipcode:

Payment by Check
Check this box if you are mailing a check.
If paying by check, print this page and mail with payment to NHSDC, 75 Main Street, PMB #113, Plymouth, NH 03264. Checks must be payable to NHSDC and should be mailed by April 30th. You should still click the Submit Registration button below. This will reserve your space until your payment is received.

Payment by Credit Card
Sorry, credit card payment is not available at this time.

Please note: You should receive an automatic email notification to confirm receipt of your registration form. Yahoo account users in particular should check their spam mailbox if you do not receive this confirmation.