1. Healthcare

NASFM 2015 A NNUAL C ONFERENCE
July 27-29, 2015
Renaissance Nashville Hotel, Nashville, TN
M EMBER R EGISTRATION F ORM
Payment Amount:
(All Registration fees will be $100 additional if registered after June 26, 2015 – all fees are non-refundable.)
Quantity
Type of Member
Price
Member
$600
Spouse/Companion (Partner Program)
$325
NASFM Life Member
Complimentary
Additional Event Tickets – July 28th
“Boot Scootin’ Saloon & Hot Tunes”
$135 each
Total
Please Note:
Member registration fee includes: All conference sessions, Day 1, 2 and 3 Lunches, Exhibitor Reception and
the “Boot Scootin’ Saloon & Hot Tunes” event – dinner and live entertainment by a singer/songwriter.
For NASFM Principal Members only, economy-class airfare (or if driving personal auto expense up to $500)
and conference lodging will be paid by NASFM.
Spouse/Companion (Partner Program) fee includes: Day 1 Brunch, Day 2 and 3 Lunches, Exhibitor Reception
and the “Boot Scootin’ Saloon & Hot Tunes” event – dinner and live entertainment by a singer/songwriter.
This does not include conference sessions or any additional activities.
Life Member: The Life Member complimentary registration includes: admission to all general sessions, Day
1, 2 and 3 Lunches, Exhibitor Reception and the “Boot Scootin’ Saloon & Hot Tunes” event – dinner and live
entertainment by a singer/songwriter.
Registrant Names (PLEASE PRINT):
1.
2.
3.
4.
Hotel Accommodations:
Hotel reservations for this meeting can be made by calling the Renaissance Nashville at 877-901-6632 and letting
them know you are with the National Association of State Fire Marshals. You can also register online at
https://resweb.passkey.com/Resweb.do?mode=welcome_ei_new&eventID=12372753. The deadline for reserving
rooms at this rate is June 19. IF YOU HAVE ADDITIONAL QUESTIONS REGARDING LODGING, PLEASE CONTACT
Peggy Beiling AT (202) 737-1226 EXT. 3.
Payment Information:
Check
Credit Card (Master
Card or Visa ONLY)
Credit Card Information (PLEASE PRINT): PLEASE NOTE – If paying by CREDIT / DEBIT card, a 4%
convenience fee will be added to your total.
Credit Card Type:
Credit Card Number:
Card Verification Number:
Expiration Date:
Name as it Appears on the Card:
I authorize NASFM to charge
(please fill in amount)to my credit
card:
Signature:
Company:
Street Address:
City, State Postal Code:
Country:
Phone Number/Fax:
Email Address:
Please send registration form and payment to:
National Association of State Fire Marshals
Attention: Phil Oakes
2015 Annual Conference Registration
P.O. Box 671
Cheyenne, WY 82003
Phone: (202) 737-1226 ext. 4; Fax: (307) 547-2260