2018 NASAE Conference Registration & Membership Form
National Association of Supervisors Agricultural Education(NASAE) Conference, October 22-24, 2018, Indianapolis, IN and 2018-19 Membership Dues (July 1, 2018 - June 30, 2019).  Upon completion of this form, an invoice will be emailed to you.   Send a copy of the invoice with your payment payable to NASAE to:  NASAE, ATTN: Charles Parker, 2910 E. Barstow Ave. MS-0115, Fresno, CA 93740-0115
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Email *
Last Name *
First Name *
Job Title *
Only 1 selection allowed.  If any titles do not fit your primary job title, click 'other' and add your own.  Title will be used for nametags.
State *
NASAE Region *
To view regional map, click - https://www.ffa.org/thecouncil/nasae/regions
Agency, Organization, State Department Name *
Spell out all words.  No abbreviations.  Answer will be used on your nametag.
US Mailing Address *
City *
Zip Code *
Office Phone *
Use this format (xxx) xxx-xxxx
Cell Phone *
Use this format (xxx) xxx-xxxx
Website *
Conference Registration Fee *
Fee includes all conference resources and 5 meal functions.  Member includes Active and Associate.  Registration after October 1st,  Member-$225,  Non-Member-$275.
Sunday, October 21 Networking - 9:30 pm *
0 - not attending      1 - attending     For all state staff 0-2 years on the job and others that would like to network for a short time.  Great conversations and snacks.
Monday, October 22 Breakfast *
0 - not attending      1 - attending
Monday, October 22 Lunch *
0 - not attending      1 - attending
Tuesday, October 23 Breakfast *
0 - not attending      1 - attending
Tuesday, October 23 Lunch *
0 - not attending      1 - attending
Tuesday, October 23 Awards Dinner *
0 - not attending      1 - attending
Tuesday, October 23 Awards Dinner Guest *
Dinner Guest Name(s)
Indicate first and last name of guests attending with you.
Dietary Needs
Please describe
Wednesday, October 24 *
Optional morning professional development.  0 - not attending      1 - attending
NASAE Membership Type *
-Active:  Members of the Association for Career and Technical Education that are engaged in the administration and/or supervision of career and technical education in agriculture on the district, area, state, or national level. ___________________                                                                                                                                                  -Associate:  Non-members of the Association for Career and Technical Education who are professionally engaged in the administration and/or supervision of career and technical education in agriculture on the district, area, state, or national level. Associate members will be allowed to vote on any business matter, but can not be elected to office or appointed to any board which includes NASAE representation. Associate members may be appointed to serve on NASAE committees.  --------------Non Member: Use 3rd option.      
New Member Pin *
Have you received a new member pin?       0-Yes     1-No
NASAE Committee
Check all committees that you would like to serve on.
Honorary Membership
Nominate a deserving individual.  Honorary Membership is reserved for individuals whose support of, and/or contributions to, the advancement of Agricultural Education are deserving of special recognition.  Honorary Membership will be granted to those individuals who have made significant contributions to the advancement of Agricultural Education, but yet may or may not have had the opportunity to participate as an active NASAE member. Individuals selected for Honorary Membership are considered a lifelong member of NASAE and are not required to pay any dues, and cannot vote or hold office but receives all other benefits and privileges of membership.
A copy of your responses will be emailed to the address you provided.
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