MAIL IN REGISTRATION / PAYMENT
PRINT THIS FORM AND MAIL IN REGISTRATION
We are excited about having you attend the 2013 ASSIST Convention.
We just need a bit of information so that we can complete your
registration packet.
Company
First
Last
Street
City
State
Zip code
Fax #
Region
Email
Phone #
DPS LC#
Attendee Type
ASSIST Member?
Participating in
Guest Names
Need Electricity?
Are you registering for a booth?
ATTENDEE INFORMATION
GUEST INFORMATION
VENDOR/ BOOTH INFORMATION
SPECIAL NEEDS INFORMATION
Please tell us if you have any special needs such as vegetarian plate or handicap access. You may also leave any other special instruction in the field below.
Tell us the names of guests attending with you. You will be able to register them on the next page.
ATTENDEE TYPE - PRICING
 
EARLY
LATE
ASSIST MEMBERS
  
$200.00
$250.00
Non - Member
  
$250.00
$300.00
Vendor/Guest/Spouse (each)
  
$75.00
$100.00
TopGun Competition
  
$60.00
$85.00
Premium Golf Tourney
 
$85.00
  
BOOTH:Member
 
$375.00
$400.00
BOOTH: NON Member
  
$500.00
$550.00
BOOTH: Electricity
 
$50.00
  
Late registration pricing begins on Sept 1, 2013
ASSIST ONLINE CONVENTION REGISTRATION
After you submit your information you will be taken to a page where you can enter additional attendees and guests. Please be sure to complete the registration process by making you payment through PayPal.
GUEST TYPES
Member - Full Member Attending Convention Gets CE
Guest/Spouse - Guest of Attendee, may or may not be member no CE
Vendor - Vendor may or not be a member may or may not have a booth
If you have already registered and just want to add a Guest please use this link  REGISTER GUEST ONLY