Conference Registration
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Registrant Information
First Name:
Last Name:
Title:
Institution/Company Name:
Mailing Address:
City:
State/Province:
ZIP/Postal Code:
Country:
Email Address:
Phone Number:
Fax Number:
Please indicate the number of years you have been employed in the testing industry: 1-3 years
4-6 years
7-10 years
11+ years
Please indicate your type of employer: 2-year Public Institution
2-year Private Institution
4-year Public Institution
4-year Private Institution
Testing Company
Testing Support Function Company
Please indicate your institution's TOTAL enrollment: Under 5,000
5,000 - 10,000
10,001 - 15,000
15,001 - 20,000
20,001 - 25,000
25,001 - 30,000
30,001 - 35,000
Over 35,000
Not Applicable
Administrative Information
Please indicate how you would like your first name to appear on your name badge:
Is this your first NCTA conference? Yes
No
Fee Section
Registration Fees: $300 - Onsite Registration (Non-Member)

OPTIONAL ENTERTAINMENT AND GUEST MEALS: The registration and payment for Optional Entertainment and Guest Meals is available on a separate registration form.

PAYMENT INFORMATION: Payment can be made by credit card or check. If paying by check, please mail your payment (payable to NCTA) and a copy of your registration confirmation to Denise Duplechin, NCTA Treasurer, 2905 LaSalle Street, Monroe, LA 71201. CASH WILL NOT BE ACCEPTED.

OVERPAYMENT REFUND POLICY: Errors made that result in an overpayment will be subject to a 10 percent penalty charge prior to any refund. Refunds will be issued after the conference.

CANCELLATION POLICY: Registration fees, less a $75 processing fee, will be refunded if a written request is postmarked (or dated for email) no later than August 20, 2010. Cancellation requests should be sent to Denise Duplechin, NCTA Treasurer, 2905 LaSalle Street, Monroe, LA 71201 or by email to treasurer@ncta-testing.org.

ADDITIONAL INFORMATION: NCTA Federal Tax ID #391666419

PRIVACY POLICY: Information gathered while on the NCTA domain (ncta-testing.org) will be stored by the NCTA and may be shared with conference sponsors and attendees. Information collected during the payment process is not handled by the NCTA and is subject to the privacy policy of the applicable site(s).