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Registration Form: 2010 Business Management Conference
January 9-11, 2010 • Sanctuary on Camelback Mountain • Scottsdale, Arizona

* indicates a required field

* First Name:

* Last Name:

* Name (as you would like it to appear on badge):

Designation(s):

Title:

* Company:

* Address:

* City:

* State:

* Zip:

* Phone:

Fax:

* E-mail:

* What is your main reason for attending the 2010 Business Management Conference? Select all that apply:

Education

Networking

Other

* How did you hear about 2010 Business Management Conference?

Past meeting

Colleague

Brochure

Internet

Other

* Have you attended the Business Management Conference in the past?
No Yes-which?

Special Needs

It is important that you enjoy the 2010 Business Management Conference. If you have any dietary restrictions, special needs, accommodations or requirements, please let us know:

Please select three of the following groups to join for the Saturday and Sunday Focused Peer Interaction Sessions:

Succession Planning
Technology/Client Management
Marketing
Strategic Alliances
TPA Best Practices
HR Issues
Electronic 5500 Filing

Registration Fees: Please note: NIPA membership is individual. If you are not personally a member or an employee of a member firm, please pay the non-member fee.
	On/before December 11	After December 11
Regular or Associate Member	$850	$950
Member Firm Employee	$900	$1000
Non-Member	$1150	$1250	(Includes membership through June 30, 2010)
Spouse/Guest (All Meal Functions)	$425	$525
Spouse/Guest (Saturday Dinner Only)	$150	$150
Spouse/Guest (Sunday Dinner Only)	$150	$150
				Registration Fee: $

Guest Program
(Guest Registration does not include access to sessions.)
Spouse/Guest Name (as you would like it to appear on badge):

Section IV - Payment Information
Total Due (includes Registration, Membership)		$

Payment Method: Registration Forms will not be processed unless accompanied by the appropriate payment.
Card Type:*
Card Number:*	(xxxx xxxx xxxx xxxx)
Expiration Date (mmyy):*
Billing Postal Code:*

All conference cancellations must be in writing. Cancellations received at NIPA Headquarters on or before December 11, 2009, receive a 50 percent refund. No refund will be given after December 11, 2009. If any circumstances or event beyond the control of NIPA causes cancellation of all or any portion of the event, NIPA agrees to refund any portion of the registration fee which NIPA is reimbursed by insurance or other third party and shall not be liable for any other refund or payment arising from the cancellation or for other liability or damages arising from the event.