NAN - National Academy of Needlearts
National Academy of Needlearts

The National Academy of Needlearts Assembly for Embroiderers 2011
Registration Form

Premier Registration Date - October 15, 2010

All registrations received by October 15, 2010 receive first day priority.

Registration closes January 22, 2011

Space in classes is limited, so register early. Please note: Your registration fee(s), less a non-refundable $100.00 class fee, will be refunded if your written notice of cancellation is received at the address below on or before January 22, 2011. Choices may be limited for registrations received after January 10, 2011.

Name:
Address:
City:
State (or Province): Zip (or Postal) Code:
Phone (Home): Phone (Cell):
Emergency Contact: Contact Phone:
Email Address:
Registration Information
Certification Workshop, March 2, 3, 4, 2011
No charge for current candidates
______ Teachers' Certification
______ Judges' Certification
Audit Fee for Certification Workshop, March 2, 3, 4, 2011 $50.00 $__________
______ Teachers' Certification
______ Judges' Certification
Assembly for Embroiderers, March 4-8, 2011
Registration Fee		 $550.00 $__________
(Includes four days of class instruction, Opening Dinner, two luncheons and the Awards Banquet)
Half Registration Fee
Saturday/Sunday $280.00 $__________
(Includes two days of class instruction, Opening Dinner and one luncheon)
Monday/Tuesday $300.00 $__________
(Includes two days of class instruction, Awards Banquet and one luncheon)
Facility Usage Fee for those not staying at the Broadmoor Hotel
4 Day Class $200.00 $__________
2 Day Class $100.00 $__________
(This is in addition to the Registration Fee)
Additional Opening Dinner Reservations #______ x $45.00 each $__________
Additional Awards Banquet Reservations #______ x $75.00 each $__________
Merchandise Night (per table) #______ x $35.00 each $__________
NAN Membership
required to attend Assembly
_____ New Member
_____ Renewing Member
$25.00
Graduate Membership = $35.00		 $__________
Angel Fund Donation
Optional		 $__________
Total Amount $__________
Would you like us to find a roommate for you? yes_____

Payment Information
Payment Method:
_______ Check enclosed
_______ MasterCard
_______ Visa
Name on Account: ______________________________
Account #: ______________________________________
Expiration Date: ________________________________
Signature:______________________________________
Is this the credit card billing address? ____ Yes ____ No

Class Selection
You MUST indicate a second choice to receive a refund due to class cancellation.

Four-Day Class: Saturday - Tuesday, March 5 - 8, 2011 Class # Teacher
1st Choice Class Name:
    
2nd Choice Class Name:
    
Two-Day Class: Saturday & Sunday, March 5 - 6, 2011 Class # Teacher
1st Choice Class Name:
    
2nd Choice Class Name:
    
Two-Day Class: Monday & Tuesday, March 7 - 8, 2011 Class # Teacher
1st Choice Class Name:
    
2nd Choice Class Name:
    

This form may be copied. Send this registration form with payment to:
Toni Gerdes
NAN Coordinator
29600 County Road 353 #42
Buena Vista CO 81211
phone: 719-395-9994

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