Registration Form

Critical Components: Mastering the College Admission Process
This area for office use only.
Registration Form
May 23 – 26, 2016 – Omni William Penn – Pittsburgh, PA
FAX AND MAIL REGISTRATION DEADLINE: MAY 16, 2016
CRITICAL COMPONENTS REGISTRATION
THREE WAYS TO REGISTER
1) Online at www.nacacnet.org/critical
2) Fax form to 703/373-2372 (credit card information must be included).
Using a credit car
d?
Register online for
the fastest and mo
st
secure registration
!
Registration Date
3) Mail form and payment to NACAC, DMT
Center; 1050 N. Highland Street, Suite 400; Arlington, VA 22201 (credit
card information or check must be included).
PLEASE PRINT OR TYPE IN FULL
BADGE INFORMATION
First Name
Middle Initial
Last Name Name on Badge (Limited to one name that will appear the largest on the badge.) Member
Non-Member
Student
Price
Price
Price*
Regular: 4/18 – 5/5
$400
$450
$225
Late: 5/6 – Onsite
$450
$500
$250
Registration fee includes the Counselors’ College Fair and Opening Reception
on Monday, breakfast, lunch and breaks on Tuesday and Wednesday. Optional
“pay on your own” networking dinners, known as Dine-Arounds, will be coordinated Monday.
*To qualify for the student rate, you must be a NACAC member and a full-time
graduate student not employed at a high school or college/university. Independent educational consultants are also excluded. Non-members who wish to
qualify for the student rate must submit an official transcript or confirmation
of enrollment with a completed registration form. Registration will not be processed without these criteria.
SUBTOTAL
Critical Components Registration$__________________________________
2016 Imagine Annual Fund
$__________________________________
Title
Institution (Contributions fund the Imagine Grants, programs supporting
public school counselors and other NACAC initiatives.)
Fund for the Future $__________________________________
Address (Contributions provide lasting support for the college admission counseling profession.)
Grand Total Enclosed
$__________________________________
City, State, Zip, Country (if not USA) Payment in full is required before registrations for this event can be processed.
Check one:
Phone
Fax
_Check enclosed (payable to National Association for College Admission Counseling)
_AMEX
Email*
_
MasterCard
 Visa
Mobile Phone (*Required. Confirmation and communication will be sent by email. Use an email you access yearround.)
Credit Card Number
Expiration Date
Printed Name
Food Allergies or Special Requests
SignatureDate
Emergency Contact
Emergency Contact Phone (Will be used only in an emergency and will be deleted immediately following the conference.)
Questions about registration?
Email: [email protected] or call 703/299-6812.
Want more information about Critical Components?
Email: [email protected] or call 703/299-6846.
For more programming for secondary counseling professionals, visit www.nacacnet.org.
TIME COMMITMENT: The most benefits will be gained by full participation in the
event (Monday, May 23 at 1:00 p.m. – Wednesday, May 26 at 4:00 p.m.), thus
NACAC recommends booking flights that arrive in the surrounding Pittsburgh area
no later than 12:00 p.m. on Monday and depart the surrounding Pittsburgh area no
earlier than 6:00 p.m. on Wednesday.
Optional College Tour visits will be held Wednesday, May 25 and Thursday, May
26. If you plan on attending the college tours, we recommend that you schedule
your departure from Pittsburgh no earlier than 8:30 p.m. EST on Wednesday and
5:00 p.m. EST on Thursday.
SPECIAL ASSISTANCE: All NACAC programs are accessible to persons with disabilities. If you require special accommodations or auxiliary aids, please notify us of
your needs in advance by calling 800/822-6285 ext. 146, 703/299-6846 or email
[email protected]
FORM OF PAYMENT: Full payment of the registration fees indicated must accompany
this form and must be received at the NACAC office by close of business (4:30 p.m.
EST) on Monday, May 16, 2016. Fees are payable to National Association for College
Admission Counseling by check or credit card. Credit card payments will appear as
NACAC on your billing statement. All applicable fees and costs for Critical Components must be paid in full at the time of registration. Registrations received without
payment will not be processed.
CC16
CANCELATIONS: To receive a full refund (less processing fee), cancelations must be
received on or before March 30, 2016. No refunds will be processed for requests
received on or after March 31, 2016, or for no-shows. Cancelation and substitution requests must be submitted in writing to [email protected] or faxed to 703/3732372. Phone calls will not be accepted. A postmark date is insufficient to meet these
deadlines. Contributions to Imagine Fund or Fund for the Future are nonrefundable.
HOUSING: Participants stay at the Omni William Penn hotel. Reservations and housing
costs are the responsibility of each participant. NACAC recommends that registrants
wait for receipt of the email confirmation before making travel arrangements.
Omni William Penn Hotel
530 William Penn Pl
Pittsburgh, PA 15219
$169.00 single/double plus 14% in state and local taxes
You can reserve housing:
1) Online at http://bit.ly/OmniCritical2016
Reservations must be received by May 5, 2016, to guarantee the
NACAC rate.
2) Phone at 1-412-281-7100. Reference “NACAC-Critical Components” when
calling in order to get the NACAC rate.
Continuing Education: Continuing Education Clock-Hours are available for the
2016 Critical Components.