2015 Spring 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: *
County: 
(NC only) 
Chapter: 
(NC only) 

*   Registration is for (CHECK ONE):        

     Number of DR. AMBROSE INTRO/INTERMEDIATE SHORT COURSE (THUR) tickets you are ordering at $25 each:   

     Note: Your $15 NCSBA Membership dues for 2014 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.)