<%@ Page language="VB" %> <% dim first first = Request.ServerVariables("first") %> PNWA - Pacific Northwest Waterways Association

2012 PNWA Annual Convention - ONLINE REGISTRATION

2012 Annual Convention
October 9-11, 2012
Hilton Vancouver Washington
301 W. 6th Street
Vancouver, WA 98660
Reservations: 360-993-4500
www.vancouverwashington.hilton.com

Personal Information:
Please note that information entered below will be reflected AS IS on your name tag & meeting materials.

	First Name
	Last Name
	Title
	Organization
	Address
	City
	State
	Zip Code
	Phone Number
	Fax Number
	Email Address*

Registration Information:

Registration Fee Before September 8, 2012: $350.00
Registration Fee After September 8, 2012: $375.00

Cancellation Policy: Registrations cancelled before September 8, 2012 will receive a full refund. Due to contractual obligations and costs incurred by PNWA registrations cancelled after September 8, 2012 are not eligible for a refund. Replacements are welcome.

Sponsor Information:


	$300	Meeting Materials
	$300	Break
	$400	Breakfast
	$500	Luncheon
	Other Amount	Enter Amount Here:
	Door Prizes	Yes! My company will provide door prizes for the luncheon on Wednesday, October 10, 2012.

Guest/Spouse Information:

We offer guests the opportunity to attend our Wednesday, October 10th luncheon at the rate of $40.00.

I will be bringing a Guest

	Guest First Name:
	Guest Last Name:

Payment Options:*

	Please bill to my business address
	I would like to use my credit card (if you choose this option, a PNWA staffer will contact you shortly for additional information)
	Complimentary registration

If you would like to include a message to PNWA with your registration form, please do so here:

*required field