2015 AFDA Mid-Winter Meeting Registration Form Birmingham Marriot Hotel – Highway 280 January 19-20, 2015 Birmingham, Alabama

Firm Name: *

Firm Address *

City: *

State *

ZIP: *

Telephone: *

Fax: *

AFTER JANUARY 13 LATE FEE WILL APPLY NO EXCEPTIONS

AFDA Member $80.00
Spouse/ Significant Other* $55.00

Student $25.00

After January 14, 2015

AFDA Member $100.00
Spouse/ Significant Other* $75.00

Registration should be completed no later than January 14, 2015 Should you have any questions, please contact Denise Edmisten at 334-956-8000.

Please print below the names of those attending exactly as you would like for it to appear on name badges: *

Please check here if you or anyone in your group requires special assistance to fully participate. Please email a written description of needs to afda06@bellsouth.net.

Please select registration type and how many that will be attending:

Total AFDA Member

AFDA Member - $80.00

Total Spouse/ Significant Other

Spouse/ Significant Other - $55.00

Total Students

Student - $25.00

You must be registered for the convention in order to receive CEU credit 2 hours for Monday Seminar 1 – 3 p.m. 1 hour – Expo 3:30 – 7 p.m.

2015 AFDA Mid-Winter Meeting Registration Form Birmingham Marriot Hotel – Highway 280 January 19-20, 2015 Birmingham, Alabama

AFTER JANUARY 13 LATE FEE WILL APPLY NO EXCEPTIONS

AFDA Member $80.00 Spouse/ Significant Other* $55.00

AFDA Member $80.00
Spouse/ Significant Other* $55.00