2012 ARTBA Northeastern Regional Meeting


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2012 ARTBA Northeastern Regional Meeting December 5-6, 2012 Seaport Hotel Registration Form ________________________________________________________________________ Name (Last, First, M.I.)

______________________________________________________________________________________ Nickname for Badge Spouse/Guest/Child Name(s) if registering for conference ______________________________________________________________________________________ Organization ARTBA Membership Division ______________________________________________________________________________________ Address E-mail address ______________________________________________________________________________________ City, State, Zip ____________________________________________ Telephone Number

_______________________________________ Fax Number

____________________________________________ Arrival Date

_______________________________________ Departure Date

General Hotel Information: Seaport Hotel & Seaport World Trade Center 200 Seaport Boulevard, Suite 500 Boston, Massachusetts 02210 Tel: 617-385-4000 Reservations can be made by calling the hotel directly. Be sure to indicate that your stay is in conjunction with the ARTBA Northeastern Regional Meeting to receive the $179 discounted room rate, which is guaranteed through November 5. Reservations after this date will be on a space available basis. Conference Registration Fees: Private Sector Non-Member Public Sector

$199 $249 Free of charge

$ ___ $ ___ _____

TOTAL PAYMENT ENCLOSED or AUTHORIZED CHARGE TO CREDIT CARD: $___________ Payment Options: 1) Check: Make check payable to "ARTBA" and mail to: ARTBA Accounting Office, The ARTBA Building, 1219 28th Street, N.W., Washington, D.C. 20007. 2) Credit Card: Credit card orders may be mailed to the address above or faxed to ARTBA’s Brie Johnson at 202289-4435 using this form. Type of card: _________ VISA _________ Mastercard _________ American Express Credit Card #: ___________________________________________ Expiration Date: ____________ Name on Card: ______________________________________ Signature: _____________________ 3) ARTBA Web-Site: Register via the Internet for the official program at www.artba.org