ATTENDEE INFORMATIONPlease fill out a separate form for each attendee.

Name: _______________________________________ Attendee Type: ________________________________Organization: __________________________________________________________________________________Address: ______________________________________________________________________________________City: __________________________________________________ State: ________ Zip: ______________Phone: ______________________________________ Email: _______________________________________ Vegetarian I need special assistance: _________________________________________________________

YES, I WOULD LIKE TO REGISTER FOR THE HOUSING LEGISLATIVE FORUM!

ATTENDEE TYPEEARLY BIRD: PAY BY 3/3

REGULAR: PAY BY 3/17 PAY ON-SITE

NLIHC Members (up to 3 from any 1 organization) $300 $350 $450 Low Income Self-Pay Member (up to 3 from 1 resident association)* $100 $125 $200 Non-Member (up to 3 from any 1 organization) $450 $500 $550TOTAL FORUM REGISTRATION FEES: $___________

For hotel rooms: Please contact the Washington Court Hotel at www.washingtoncourthotel.com — the sooner the better (space is limited) — but no later than March 17, 2017. Be sure to mention Group Code NLIHC2017.

YES, I WOULD LIKE TO BUY A TICKET TO THE 2017 LEADERSHIP RECEPTION!This Event will be held on Tuesday, April 4, 2017 at the Washington Court Hotel.

ATTENDEE TYPE TICKET COST

Members (Organizational or Individual): $100 All Other Non-Members $200

TOTAL LEADERSHIP RECEPTION FEES: $___________

TOTAL AMOUNT DUE: $___________Registrations will not be processed until payment is received. Registration closes March 17, 2017 at 11:59 pm ET. All registrations received after March 17, 2017 will be treated as walk-in registrations. Cancellation Policy: A 75% refund of paid registration rates will be available until March 3, 2017.*People who identify themselves as low income and self-pay, including residents of public and assisted housing, voucher holders, students, seniors, VISTA and AmeriCorps volunteers.

PAYMENT INFORMATION I have enclosed a check. Visa MasterCard

Credit Card Number: _____________________________________ Exp. Date: __________ CVC: _______

Cardholder Name: ______________________________ Cardholder Signature: ___________________________Mail your completed form with payment to NLIHC, 1000 Vermont Avenue NW, Suite 500, Washington, DC 20005 Registrations can also be faxed to 202-393-1973, but must include credit card information. For assistance, please call 202-662-1530 x226.

GO GREEN! Registration is quick and easy through our secure website nlihcforum.org

NLIHC 2017Housing Policy Forum

APRIL 2-4, 2017

nlihcforum.org

Washington Court HotelWashington, DC

10/14/2016

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