Registration Form

Attendee Information

Name(Required)

Prefix First Last

Member ID

I'm Attending(Required)

In-Person

Virtually (Home or Office)

Nickname for Badge

Job Title

Company / Agency:

Email(Required)

This email address will be used for confirmations, updates, and badge pick-up instructions. Exhibitors and sponsors are permitted a one-time use of attendee email addresses for promotional purposes unless you check the consent box. We will NOT sell your email address.

Alternate Email Address (Optional)

Provide a backup email in case your primary email is unavailable, so you don’t miss any event updates or confirmations. We will NOT sell your email address.

Phone

Role Within The Organization:

Executive

Mgmt./Supervisory

Staff/Analyst

Operations

Other

Primary Responsibility Area:

Registration Fees

Please note that in-person and virtual registration fees are the SAME

Early Bird

Registration form submitted by January X.

AGA Members $675

Non-members $850

Regular

Registration form submitted by January X.

AGA Member $575

Non-Member $750

Method of Payment

Cancellation, Substitution & Refund Policy: Please visit the NLT Registration Website for more information on deadlines and additional fees. PO/SF-12, use this this form. Credit card, visit the NLT Registration website. Phone and mail registrations are not accepted.

PO/SF-182/Check #(Required)

File(Required)

Please include a copy of the PO/SF-182 or check to validate your registration

Max. file size: 1 MB.

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