Register as an individual NGAUS National Conference 2017 Membership Type*SelectAnnual MemberActive Life MemberRetired Life Member Sign up now for an Active Life Membership and NEVER pay national or state dues again. The Active Life Membership is $750.00 through December 31, 2017. If you have already paid your 2017 dues you may subtract that amount from the total. You will also be eligible for the NGAMS Scholarship Fund. If you have questions, contact Greg Taylor at 601-354-7555 or email email@example.com.Check one if applicable:*RetireeCurrent TAGFormer TAGI would like to be considered as a delegate for my stateOn TDYPlease check as applicable:*First time attendeeTwo-five times attendedSix or more times attendedNumber Registering*Select123Full Name* 2LT2d Lt1LT1st LtCPTCaptMAJMajLTCLt ColCOLColBGBrig GenMGMaj GenW01CW2CW3CW4CW5CPT (R)Capt (R)MAJ (R)Maj (R)LTC (R)Lt Col (R)COL (R)Col (R)BG (R)Brig Gen (R)MG (R)Maj Gen (R)W01 (R)CW2 (R)CW3 (R)CW4 (R)CW5 (R) Prefix First Middle Last Suffix T-shirt size*SelectSmallMediumLargeX-LargeXX-LargeXXX-LargeName on BadgeAddress* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* By providing an e-mail address, NGAUS will be able to send to you conference updates, special event invitations, etc.Phone (Preferably Cell)*Spouse or Guest RegistrationCheck one if applicable*No Spouse or GuestSpouseGuestSpouse/Guest Mr.Mrs.MsMs.Dr.Prof.Rev. Prefix First Middle Last Suffix Name on BadgeT-Shirt SizeSelectSmallMediumLargeX-LargeXX-LargeXXX-LargeGuest 2 Mr.Mrs.MsMs.Dr.Prof.Rev. Prefix First Middle Last Suffix Name on BadgeT-Shirt SizeSelectSmallMediumLargeX-LargeXX-LargeXXX-LargeConference EventsCheck which of the following events you and/or your guest(s) will attend.CG/WO Mixer (No fee)Thursday, September 7, 2017 7:00 PM - 11:00 PM The Sports and Social Club at Fourth Street Live!SelectRegistered MemberGuestBothNGAUS Member Golf Tournament ($125.00)Registered Member ($125.00)Guest ($125.00)Both ($250.00)Thursday, September 7, 2017 8:00 AM-3:00 PM Persimmon Ridge Golf ClubFun Run $20.00 per personRegistered Member ($20.00)Guest ($20.00)Both ($40.00)Friday, September 8, 2017 7:00 AM - 9:00 PM Louisville Waterfront ParkOfficer Professional Development (OPD) (No fee)OPD Sessions will be held Friday, Saturday & Sunday. Final locations and exact times will be published in NGAUS program.Governor's Reception (No fee)Registered MemberGuestBothFriday, September 8, 2017, 6:30 PM - 10:00 PM, Churchill DownsSpouses Lunch (No fee)Saturday, September 9, 2017 11:00 AM - 1:00 PM Galt House HotelGuestWarrant Officer Luncheon and Caucus (No fee)Registered MemberGuestBothSaturday, September 9, 2017 12:00 PM - 2:30 PM TBDRetiree Lunch $5.00Saturday, September 9, 2017 12:00 PM - 2:30 PM TBDRegistered MemberGuestBothStates Dinner (Derby Attire) (No fee)Sunday, September 10, 2017 7:30 PM - 10:00 PM Kentucky Exposition CenterRegistered MemberGuestBothAccommodationsYour state’s hotel room block is the Louisville Marriott Downtown. A $100 deposit is required to reserve a room.Will you require a hotel room? ($100.00 Deposit)*Yes ($100.00)NoCheck-in Date (MM/DD/YYYY) Check-out Date (MM/DD/YYYY) TransportationArrival AirlineFlight #Arrival Date (MM/DD/YYYY)*Arrival Time* : HH MM AM PM Departure AirlineFlight #Departure Date (MM/DD/YYYY)*Departure Time* : HH MM AM PM PaymentRegistration Fee Price: $ 0.00 Hotel Deposit Price: $ 100.00 Conference Event Fees Price: $ 0.00 Total $ 0.00 PhoneThis field is for validation purposes and should be left unchanged.