2014 FMA 27th ANNUAL CONFERENCE REGISTRATION Through the Looking Glass May 7, 8, 9, 2014 (Complete one form for each person registering from your agency) Early Registration (with payment) Must Be Postmarked by Friday, April 4, 2014 AGENCY INFORMATION: AGENCY_____________________________________________ ADDRESS____________________________________________ CITY____________________STATE______ZIP_____________ PHONE____________________ FAX______________________ REGISTRATION INFORMATION: Full name as you would like it to appear on nametag—PLEASE TYPE Name_____________________________________________ Title______________________________________________ Email address______________________________________ CPA # (if you want CPE Credit) ______________________ Registration Fee Member Non-Member 3 days $100___ 3 days $125 ___ 1 day $75 ___ 1 day $100 ___ Registration postmarked after 4.3.13 3 days $125 ____ 3 days $150____ 1 day $100 ____ 1 day $125 ____ *Registration fee includes Wednesday lunch Conference Registration Fees: Make check payable to: FMA Conference Total Amount Enclosed: $ _______ Mail check & registration form (s) to the following: Please note that the address has changed from last year FMA Conference / Suzette Smith c/o The Resource Center 200 Dunham Avenue Jamestown, NY 14701 Note: We apologize for the inconvenience but we are unable to accept credit card payment. Payment must be made by check. Hotel Reservations must be made directly with The Otesaga using the attached registration form. Rooms at The Otesaga will be filled on a first reserved basis. Overflow rooms at The Cooper Inn will be used. We also have a block of rooms reserved at two other hotels. Rooms at both locations will be held until April 1st. To make a reservation call the # listed and provide the reservation code. Holiday Inn Express 607-547-8000 Code: “FM1” Meal information: Wednesday lunch is included with your Conference Registration. Attendees staying at the Otesaga/Cooper Inn: all meals, Wed. dinner through Friday lunch are included. Attendees staying at other locations or coming for one day may purchase other meals by completing the attached meal form. Questions - please Suzette Smith @ 716-661-1001, email @[email protected], Sandy Radziwon @ 607-352-3304, email @ [email protected] or Pam VanPatten at 315-478-4151, email at [email protected] Cancellation Policy: Refunds for Conference Registrations will be issued if we are notified prior to April 12, 2014. Substitutions can be made by notifying us prior to the conference. Refunds will be issued after conclusion of the conference. 2014 FMA Conference 27th Annual Conference May 7, 8, 9, 2014 Meal Information For attendees that are staying at a location other than the OTESAGA or the COOPER INN, or if you are coming just for the day and you wish to join us for meals, Please complete the information below and submit payment with your Conference Registration. (Please complete one form for each person registering from your agency) I am staying at another location ______ to purchase the following meals: or am attending for one day only _____ and would like Wednesday Dinner (5/7/14): $65.00 Thursday Lunch (5/8/14): TOTAL: ___________ $20.00 ___________ $ ___________ Attendees Name: ________________________________________ Agency: ________________________________________________ Please make check payable to: FMA Conference and submit with your conference registration form. You will receive your meal ticket(s) at registration! Note: If you are staying at the Otesaga or the Cooper Inn your meals are included with your hotel package.