Leahy Associates, Inc.

NCCPS PARTICIPANT REGISTRATION FORM

Instructions:

  • If you are paying by check, money order or purchase order please click here.
  • If you are paying with a Mastercard or Visa please complete the form below.
  • Please complete a registration form for each participant.
  • Please provide all required information; items marked with an (*) asterisk are required.
  • You will receive a receipt and further conference information via email.

* Participant First Name:
* Participant Last Name:
* Organization:
   Position:
* Participant Email:
* Participant Home Address:
* Participant Phone:
* Participant is under 21?: Yes    No
* Organization Website/Email:
* Organization Mailing Address:
   Organization Billing Address (if different):
* Organization Phone:
   Organization FAX:
   Send Future Correspondence to: Home    Organization

Glossary:

First Time Full Conference: Applicable to first time participants. Fee includes all three days of the full conference; Thursday-Saturday.

Alumni Full Conference: Applicable to individuals who have previously attended the "Full" conference or a Leahy & Associates workshop in previous years. Alumni rates ALSO apply to employees of any organization that have sent other employees to NCCPS or a Leahy & Associates workshop in previous years. Fee includes all three days of the full conference; Thursday- Saturday.

Student Full Conference: Applicable to any individual under the age of 18 or with a valid college ID and enrolled in 12 or more credit hours during the semester of the conference. Fee includes all three days of the full conference; Thursday-Saturday.

Vendor: Includes one full conference registration and a table to display and sell your products and services during the full conference. Vendors may not sell their products and services in another presenter’s workshop. Overnight storage provided if requested, though we cannot guarantee security. Fee includes all three days of the full conference; Thursday-Saturday.

Peddler: Includes one full conference registration and a “peddler’s” license to travel about NCCPS selling your products (Thursday-Saturday). The peddler’s license does NOT include a table/display. Peddlers may not sell their products in another presenter’s workshop. Overnight storage provided if requested, though we cannot guarantee security. Fee includes all three days of the full conference; Thursday-Saturday

Daily: Applicable to any individual who attends any single day(s) of NCCPS.

Group Discounts Available! Call 303.673-9832 for details. Sorry, no group discounts for student rates.

Full Conference Fees Earlier Bird
by 12/31/2011		 Early Bird
by 1/31/2012		 After
1/31/2012
First Time$300$325$350
Alumni $250$275$300
Student $175$200$225
Vendor $450$550$650
Peddler $350$450$550
 
Daily
$125/day		 Thursday Friday Saturday
 
Facilitator's Formal
February 24, 2012
6:30pm - 10:30pm

(Dinner included w/ purchase of full conference registration)
* I will be there in my fancy clothes! Yes    No
I cannot attend the full conference but I would like to celebrate with everyone on Friday night $25
Vegetarian Yes    No
Food Allergies?
 
Wilder Space
February 22, 2012
8:00am - 5:00pm
This sounds like fun!
Count me in!
I will need a ride
I will not need a ride
I can fit    additional people in my car.
 
Post-Conference Workshop
February 27 - 29, 2012		 Presenter Length Workshop Fee
The Innovative Team
(Best Western Plus Boulder Inn)		 Tom Leahy Full Day
8:00am - 6:00pm		 $300
(with full conference)
 
Meal Plan
Thursday Lunch $12
Thursday Dinner $15
Friday Lunch $12
Saturday Lunch $12
Vegetarian Yes    No
Food Allergies?
 
How did you hear about NCCPS?
Applicable Discounts / Comments:


Refunds and Conference Cancellation Policies

Refunds:

To qualify for a refund, YOU MUST CALL BEFORE the conference or the date of your pre-conference workshop. You then have 30 days to submit your written request. Tuition less a $50.00 processing fee is refundable up to 30 days before the start of the Conference (January 22, 2012). Refunds after that date are issued less a $100.00 processing fee.

No Shows:

No refund.

Full Conference or Pre/Post Conference Workshop Cancellation:

If the full conference is canceled, participants will receive a 100% refund. If a pre/post conference workshop is cancelled, participants will receive a 100% refund or may apply the balance to any other workshop that has space.

 
Leahy & Associates, Inc. • 7013 Roaring Fork Trail • Boulder, Colorado 80301 USA
phone: 303-673-9832 • fax: 303-604-1901      © 2011 Leahy & Associates, Inc.
Photo credits: Michael Peterson, Jeff Chow, Rick Thompson, Paul Cummings, and Tom Leahy.
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