2015 Summer Conference Registration Form
Submitted Electronically,  for Current NCSBA Members Only
Payment due on arrival at the meeting.

* = required field.

ID Number:   (NC members only from membership card or contact Laurie Shaw at 919-585-6052)
First name:  *
Last name:  *
Address Line 1: *
Address Line 2:
City:   *
State:   *
Zip: *
Telephone: *
(NC only) 
(NC only) 

*   Registration is for (CHECK ONE):        


     Number of NCSBA BANQUET (FRI) tickets you are ordering at $25 each:   

     Note: Your $15 NCSBA Membership dues for 2015 will be added if not paid by the meeting date.

For FAMILY registration, list family members who will attend:
Spouse's Name:    
Children's Names: (separate names with commas)

Enter  email  address : to receive confirmation.
Repeat email address: for accuracy.

Add any brief comments you wish to send to registrar. (max 200 char.)

(THIS IS NOT FINAL -- you can REVIEW, EDIT, CANCEL, or CONFIRM after clicking SUBMIT.)