Fillable Printable NAGC Student Registration Form

NAGC Student Registration Form

Student Registration Form

NAGC Member Number _____________  This is my ﬁrst NAGC Convention  I am a Presenter

First Name __________________________ Last Name _________________________________ M.I. _________

Mailing Address [home or work] ____________________________________________________________

City ____________________________________________ State ______________ Zip Code _______________

School/Organization Name ____________________________________________________________________

Professional Title ____________________________________________________________________________

Work Phone _________________________________ Home Phone ____________________________________

E-mail (primary) _____________________ home or work (secondary) _____________________ home or work

Please use a separate form for each attendee. Photocopy as needed.

Do not use this form if you are an Individual/Exhibitor/Group

Find registration forms online at www.nagc.org/2015convention

Attendee Information

Subtotal for Registration Fee $ ______________

Additional Registration Options and Payment



Do you require any special accommodations to participate (wheelchair, dietary restrictions, etc.?)  YES  NO

Explain ____________________________________________________________________________________

Do you wish to be excluded from exhibitor mailings?  YES  NO

Convention Registration (Thursday, Nov. 12, 3:00 pm - Sunday, Nov. 15, 12:00 pm)

* Membership + Convention Bundle includes your Convention registration PLUS a one-year NAGC Graduate Student

Membership. Beneﬁts include member pricing for books and professional development, subscriptions to Teaching for High

Potential, Gifted Child Quarterly, and Compass Points. Choose three NAGC Networks as part of your membership:

 Arts

 Computers & Technology

 Conceptual Foundations

 Counseling & Guidance

 Creativity

 Curriculum Studies

 Early Childhood

 GLBTQ (Gay, Lesbian, Bisexual,

Transgender, Questioning)

 Global Awareness

 Middle Grades

 Parent & Community

 Professional Development

 Research & Evaluation

 Special Populations

 Special Schools/Programs

 STEM (Science, Technology,

Engineering & Math)

In order to register as a Student, include your class schedule when registering.

Mail (accepted until Oct. 30)

1331 H Street, NW Suite 1001

Washington, DC 20005

You must include a copy of your class schedule when registering.



Registration MUST be

postmarked by the

deadline noted

Early Bird Registration

(April 15 - September 21)

Advance Registration

(September 22 - October 30)

Onsite Registration

(October 31 - November 15)

 $299

 $358

 $400

 $349

 $408

 $425

 $379

 $438

 $455

NAGC Member

Nonmember

Membership +

Convention Bundle

Best

Value

For Your Convention Name Badge (if you are not aliated with a company or school, include your home city and state)

First Name or Nickname as it should appear on your badge ______________________________________________________

Company or School Name _______________________________________________________________________________

City __________________________________________________________________ State _________________________

** No membership included

NAGC

Pre-Convention

Programs

Payment Method:  Check  Mastercard  Visa  AMEX  Discover

 Purchase Order #____________ (Attach original PO with form)

Name on Card ______________________________________________________________________

Card Number _______________________________________________________________________

Exp ____________ Card Veriﬁcation # ___________ Billing Address Zip Code _____________

Signature __________________________________________________________________________

Total Due in U.S. Funds $ __________

PAYMENT

All registration forms must include payment

Made payable to NAGC

Check No. ___________

Cancellation/Change/Substitution Policy

NAGC Convention cancellations must be received at NAGC in writing, by mail or fax,

no later than Friday, October 30, 2015, and will be charged a $100 processing fee.

This fee applies to cancellations, substitutions, and changes to your registration.

Refunds issued after January 6, 2016. Osite Educational Programs Fee is not refundable after

October 12, 2015.

Please consider making a tax-deductible donation to support NAGC programs that build awareness of the

needs of high-ability learners.

Donation Amount $ ______________

Donate to the naGC annual FunD

Subtotal for

Pre-Convention Events $ ____

Thursday, November 12 (choose only one)

Gifted Education Workshops for Teachers: Practical and Eective Strategies, Solutions, and

Resources for the Classroom 9:30 am - 3:15 pm $149 (includes lunch)

Select morning session (AM1 - AM5) _____________ Select afternoon session (PM1 - PM5) ______________

See pages 10-15 in the preliminary program for description and presenter bios



Wednesday, November 11

For details and descriptions for all pre-convention opportunities

visit www.nagc.org/2015convention

Osite Educational Programs

7:30 am - 2:30 pm (Exact times

vary and will be provided to registrants)

$149 (price does not include lunch)

Choice ___________

Identifying and Serving Gifted and Talented Native

American Students: Future Directions for Research,

Partnerships and Practices

8:00 am - 2:30 pm

$149 (includes lunch)

Your NAGC Convention registration begins with the opening general session at 3:00 pm on Thursday, November 12

1331 H Street, NW Suite 1001

Washington, DC 20005

 An additional fee is required, separate from Convention registration.

 Please register early -- spots ﬁll quickly as registrations are received.

 Registrations for Osite Educational Programs must be postmarked

by October 12.

 Pre-Convention Activities without sucient attendees may be

cancelled in advance by NAGC.

Visit www.nagc.org/2015convention for details and descriptions.



See pages 17-18 in the preliminary program for descriptions

by 10/12