GENERAL INFORMATION
(Print/Type information EXACTLY as you wish it to appear on the registration roster).
 
ONLINE REGISTRATION FORM:
* Indicates required field
 
(Mr. Ms. Dr).    *
First Name:    *
Last Name:    *
MI:   
Nickname (for badge):    *
Title:    *
Company:    *
Address:    *
Address 2:    *
City:    *
State:    *
Zip:    *
Phone:    * (XXX) XXX-XXXX
Fax:    (XXX) XXX-XXXX
Email:
(mandatory for processing)
   *
 
     If you require special assistance to fully participate in the conference please complete the box below with your special needs request. Thank you
 
REGISTRATION FEES:
.
Item Cost Total
Registration (Includes breakfast, breaks and lunch as well as meeting materials) $200 $
Please check here if you will attend the Reception/Dinner on Wednesday, October 16. (Complimentary thanks to sponsors) 0
    Total $
 
** Industry suppliers who wish to attend the meeting and serve on the Committee must join AFSA. For details and membership information please contact Jenny Bengtson at 202-296-8530 or email [email protected]
PAYMENT INFORMATION:
Enter Credit Card Information
Click here to use registration information above for billing
Name on Card:
First Name:
Last Name:

Card Information:
Card Type:
Card Number:
Expiration Date:
Card Verification Number:

Billing Address:
Street Address:
City:
State:
ZIP Code: (5 or 9 digits)
Amount $:
 
HOTEL INFORMATION:

Meeting Location:
Harbor Beach Marriott Resort & Spa

3030 Holiday Drive
Fort Lauderdale, Florida 33316
Phone: (954) 525-4000

Please CONTACT THE HOTEL DIRECTLY (954) 525-4000 to reserve your guest room at the special AFSA rate of $169 plus tax single or double occupancy. The reservation deadline is Monday, September 23. However, rooms are available on a first-come, first-served basis. The block almost always fills before the registration deadline. Please reserve your hotel as early as possible to ensure availability.

AIR & GROUND TRANSPORTATION INFORMATION:

 
If you choose to rent car we encourage you to use Enterprise and take advantage of the special AFSA discount by entering the following discount code 16AH072.

CANCELLATIONS & REFUNDS:
All registration cancellations and refund requests must be made in writing to Jenny Bengtson, at AFSA, 919 18th Street, NW, Suite 300, Washington, DC 20006 or email [email protected] Full refunds will be given until 1 week prior to the first day of the meeting and substitutions can be made at any time
QUESTIONS:
If you have questions about registration please contact Jenny Bengtson at AFSA 202-296-8530 or [email protected]. If you have general meeting questions please contact Michele Battaline at 202-776-7302/ [email protected].


For More Information Contact the Meetings Department
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