Registration for Members: Please enter your member for discount rates: Member Id: 10 ( enter the next 4 numbers of your member id.)   Clear Agency Name First Name Last Name Address Apt / Suite City State Postal Code Email Address: Phone Number:     Will you be attending the SAMHSA Community Corrections/ORP Grantee Meeting? No Yes Do you require Vegetarian Meals? No Yes Do you require other special Accommodations?   Select Registration Option: Enter the quantity of the tickets you wish to purchase on the left: Non-Member Price $ In-state Rate $275 Single Day Admission $ Specify Date: Choose A Date March 21st March 22nd March 23rd (March 21st, 22nd, or 23rd) Final Total $   Registrant Names: Please list all of the registrants first and last names By registering, I understand no refunds will be issued for cancellations. Name substitutions are allowed up until the start of the conference. To qualify for the special lower rates, your registration form AND payment must be received by February 15, 2012.
©2011 NATIONAL TASC 1025 Connecticut Ave. NW, Suite 605   Washington, DC 20036 P: (202) 293-8657   F: (202) 293-1250   E-mail Us