NAIA Digital Seminar Registration
Rollins College, Winter Park, FL,
December 5, 2004

Name: ________________________________________________
Address: ______________________________________________
City, State, Zip: _________________________________________
Telephone: Day/Evening/Cell _____________________________
Email: ________________________________________________

Are you a current NAIA member? Y___ N___
If you are not a current NAIA member and wish to join, you may do so and receive the member discount for this seminar. Go to https://naia-artists.org/join/index.htm

Seminar Fees: Check those that apply.

NAIA Members only:
___ $ 25.00 ? NAIA member
___ $ 20.00 ? Spouse or artist assistant registering at the same time
Name of Spouse or Artist Assistant: ___________________________
Total: $____

Non-NAIA Members:
___ $ 30.00 ? non-NAIA member
___ $ 25.00 ? Spouse or artist assistant registering at the same time
Name of Spouse or Artist Assistant: ___________________________
Total: $_______

Rollins College Students:
___ FREE with Student ID - Print out this page, fill out and mail to address below.

Payment methods:

Check: Fill out and mail this Registration form, along with your check
payable to NAIA, to the address below.
Credit Card: Fill out this this Registration form, including your credit card
information, and mail to the address below.

Credit Card
Name on card: __________________________
Credit card: _____________________________
Expiration: _____________________________

MAIL TO:
NAIA Digital Seminar
c/o Ardath Prendergast
72 Douglas St.
Homosassa, FL 34446

Space is not guaranteed until your payment is received.
Back to Digital Seminar page