2011 NC Public Transportation Conference and Trade EXPO Participant Registration

Please fill out the form below to complete your online registration:

* indicates a required field for form information to submit correctly.

First Name* First Name is required.Last Name* Last Name is required.

Guest Name

Your Title* Your Title is required.

Transit Organization* Organization is required.

Address* Address is required.

City* City is required.

State* State is required.

Zip* Zip is required.

Phone* Phone Number is required.

E-mail Address:* Email is required.Invalid format.

I am requesting registration for the following events:

Annual Conference and Trade EXPO May 23-25, 2011

I will make payment by:

Check (no need to click on the "add to cart" buttons, only check box)
Credit Card or other PayPal transaction (Use "add to cart" buttons AND check box.)
(PayPal account is not required to make a credit card payment through our PayPal merchant system.)

IMPORTANT:**You must click "SUBMIT" at the bottom of the page for your registration form to be sent to NCPTA- PayPal is only the payment...not your registration for the conference***

(check only one participant type) *

Late Registration (after April 15)

Participant Member - $250

Participant Non-Member- $300

Participant with discount of 20% ($160) because I am one of 5 people registering in my organization.

Student - $100

One day only participant (any day) - $80

Today's Date:

Late fee (after April 15) - $50 additional *

Please indicate if the following applies to you:

New Attendee ?
Yes No

Golf Tournament - Sunday, May 22, 2011

Golf - $35 (pre-registration is required)

Please list Handicap or Average Score:

Registration includes meals. Please indicate which meals you plan to attend:

May 22, Sunday - Vendor Reception

May 23, Monday - Breakfast Buffet Luncheon Vendor Reception

May 24, Tuesday - Breakfast Buffet Luncheon Dinner Reception
Will you have a dinner guest? No Yes
Note: Guest dinner cost will be collected at conference check-in.

May 25, Wednesday - Breakfast Buffet

Do you have any special dietary requirements? *

No Yes, please explain:

Do you require an ADA accommodation? *
No Yes, please explain:

Your total is: IMPORTANT:**You must click "SUBMIT" at the bottom of the page for your registration form to be sent to NCPTA- PayPal is only the payment...not your registration for the conference - YOU WILL BE DIRECTED TO MAKE YOUR PAYMENT THROUGH PAYPAL IN THE NEXT SCREEN*****.

Please note CONFERENCE REGISTRATION NUMBER,guest names and "Conference" in the memo of check or money order and mail so that NCPTA will receive by April 15, 2011. Registrations received after April 15, 2011 must include a late-registration fee of $50.

Mail the confirmation email with a check or money order (payable to NCPTA) to:
Dennis Williams
Alamance County Transportation Authority
PO Box 2746
Burlington NC 27216-2746

If this page doesn't give you a "thank you" message after you click submit, scroll UP to see if you included answers to all required fields or view to error message by field with error.