For Office Use Only

Initials

Date

Ck #/Amount

Deposit #

Notes

NACADA FEIN number: 48-1114759

Payment Information – pay in U.S. Dollars from a U.S. Bank – Thank You

Method of Payment (choose one):

Check (payable to NACADA): #_________________________ *Returned check fee is $35

Agency Purchase Order (PO): #___________________________ * PO MUST be attached

Credit Card (choose one): Visa Master Card American Express Discover

Cardholders Signature Required: __________________________________________________ I certify that I will secure payment for the total amount due.

Name on card (print): ________________________________ Billing Zip Code: ____________

Card Number: __________________________ Expiration Date: _______ CVV Number: _____

Questions & Information

Website: www.nacada.ksu.edu

Email: nacada@ksu.edu

Phone: (785) 532-5717

Registration in this meeting authorizes

NACADA to include you in event photos to

be shared with the group or in

promotional materials in the future. If you

wish to opt out of these photos, please

email your request to nacada@ksu.edu .

Check the registration fee that applies On or Before Jan 30, 2018

After Jan 30, 2018

Current Member Does NOT include membership fee

$140 $190

Student/Retiree Does NOT include membership fee

$100 $100

Non-Member You acknowledge that no reimbursement for lost discounts

will be made, even if membership status changes.

$240 $290

Preconference Workshops

Preconference Workshops will be posted closer to conference. You can register for them online at that time.

Total Due: _________

February 20-22, 2018, Little Rock, AR

2018 Conference Registration – Region 7

Registration may be made via:

Fax: (785) 532-7732

Online: www.nacada.ksu.edu

Mail: NACADA 2018 Region 7 Conference

2323 Anderson Ave, Suite 225

Manhattan, KS, 66502-2912

All individuals, including presenters,

must register and pay the conference fee.

Last Name: ______________________ First Name: __________________ MI: ____

Nickname: _____________________ Job Title: ______________________________

Email: ________________________________________________________________

Institution: ____________________________________________________________

Address: _______________________________ City: _________________________

State/Province: ________ Postal Code: _________ Country: __________________

Business Phone: _______________________ Home Phone: ____________________

Registrant Information

Emergency Phone: _____________________________________________________

List vegetarian, vegan or severe food allergies: _______________________________

List ADA physical accessibility need: _______________________________________

I would like to volunteer This is the 1st NACADA event I have attended.

To receive Member Discounts: 1. Complete membership form on

page 2, including credit card

information or attach check

OR

2. Join on-line at www.nacada.ksu.edu

Cancellation and Refund Policy

All requests must be in writing and mailed or

emailed (nacada@ksu.edu) to NACADA.

On or before January 30, 2018: A refund of

conference fee, less $25.

Between January 31, 2018 – February 13,

2018: Eligible for 50% refund of conference

fee.

After February 13, 2018: Due to facility and

conference obligations, no refunds are

given.

*Registrations may be transferred to

another individual from your institution.

*If the conference is cancelled, registration

fees will be returned.

MEMBERSHIP INFORMATION

To join or renew membership at this time (and receive member discounts) you may:

Apply online for immediate confirmation of your membership status at www.nacada.ksu.edu OR

Attach this form with a check (mail) or credit card (fax or call).

< 3 years 3-5 years6-10 years11-15 years>15 yearsN/A

Ethnic Background: Amerindian/First Nations Asian Black (non-Hispanic) Latino/Hispanic Multi-ethnic White (non-Hispanic) Other Prefer Not To Answer

Faculty Advisor

Academic Advisor

Academic Counselor

Advising Administration

Licensed Counselor

Non-Institutional

Student

Other

Prefer Not to Answer

Gender: Female Male Nonbinary Prefer Not To Answer

Birth Year: ___________

Method of Payment (choose one): Payment must accompany form

Check (payable to NACADA): #_______________________ Returned check fee is $35

Credit Card (choose one): Visa Master Card American Express Discover

Signature for Credit Card below: __________________________________________________

Periodically NACADA distributes mailing lists to other

educational entities. To be excluded, check the box

You may choose any four (4) of these specific advising areas: Refer to www.nacada.ksu.edu for further information on Commission and Interest Group membership

Advising Specific Populations III CIG601 High School to College Advising CIG602 Commission for LGBTQA Advising and Advocacy CIG603 Multicultural Concerns CIG604 Probation/Dismissal/Reinstatement Issues CIG605 Undecided & Exploratory Students (CUES) Institutional Type CIG701 Advising at Historically Black Colleges & Universities CIG702 Canada CIG703 Large Universities CIG704 Native American & Tribal College CIG705 Small Colleges & Universities CIG706 Two-Year Colleges Theory, Practice and Delivery of Advising I CIG801 Advising & Academic Coaching CIG802 Appreciative Advising CIG804 Faculty Advising CIG806 Peer Advising & Mentoring CIG808 Theory & Philosophy of Advising Theory, Practice and Delivery of Advising II CIG901 Career Advising CIG902 Distance Education Advising CIG903 New Advising Professionals CIG904 Technology in Advising CIG906 Orientation Advising

Administration of Advising CIG101 Advising Administration CIG102 Advisor Training & Development CIG103 Assessment of Advising CIG104 Ethics & Legal Issues in Advising Advising in Academic Programs I

CIG201 Advising Business Majors

CIG202 Advising Education Majors

CIG203 Advising Fine Arts Students

CIG204 Advising Graduate & Professional Students

CIG205 Doctoral Students

Advising in Academic Programs II

CIG301 STEM Advising

CIG302 Health Professions Advising

CIG303 Liberal Arts Advisors

CIG304 Pre-Law Advising

Advising Specific Populations I

CIG401 Advising Adult Learners

CIG402 Advising First-Year Students

CIG404 Advising High Achieving Students

CIG405 Advising Student Athletes

Advising Specific Populations II

CIG501 Advising Students with Disabilities

CIG502 Advising Transfer Students

CIG503 Advising Veterans, Military Students & Family MembersCIG504 Global Engagement

CIG505 First-Generation College Student Advising

Join or Renew Your Membership

For Office Use Only

Initials

Date

Ck #/Amount

Deposit #

NACADA FEIN number: 48-1114759

$75 General Member $95 Associate Member $175 Institutional Member $20 Student Member (Employed by an accredited institution) (Not employed by an accredited institution)

Name on card (print): _______________________________________ Expiration Date: ______________

Card Number: ____________________________________________________ CVV Number: __________

Role Demographic Information Years Advising

Last Name: __________________________________ First Name: ___________________________ MI: __________

Institution: _________________________________________ Email: ________________________________________