2018 DASA SUMMER INSTITUTE

Attendee Registration Form
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To Download and Print Registration Form

Or Register Below . . .
2018 DASA Summer Institute Online Registration Page
Friday, July 27 Thru Sunday, July 29 2018

JW Marriott Marco Island Beach Resort (Click Here For Complete Hotel Information)

DASA REGISTRATION INCLUDES: All Sponsored Conference Activities * Exhibit Hall Visitation * Welcome Reception * Continental Breakfast * Dinner * After Party *Sunday Brunch * Key Note Speaker* Conference Materials.

SPOUSE/GUEST REGISTRATION: All Sponsored Conference Activities * Exhibit Hall Visitation * Welcome Reception * Continental Breakfast * Dinner * After Party *Sunday Brunch * Key Note Speaker*

*CHILDREN: * hours during cocktail party, Presidents Dinner and After Party . MUST REGISTER / PAY by June 9 to take advantage of the $60 price!!

REFUND POLICY: Written requests for refunds will be granted until June 29th. There will be a $30 administrative charge on all refunds. No refunds will be made after June 30, 2018.

Dr. Mr. Mrs. Ms.

First Name:

Last Name:

School/Work Location:

Position:

Contact Phone:

E-Mail Address:

Verify E-Mail:

Home Address:

City: State: Zip:

DASA Member?:

I will be bringing the following guest(s):

If Yes, please list below your guest's name(s) as it should appear on badge,
i.e. (Salutation) (First Name) (Last Name):

Child(ren) Ages 5-15 (Attending “Kid’s Night Out” Saturday 6:30pm- Midnight ):
No Yes

Children
If "No Children" Skip This Section

For each child please complete the following.

Child One First Name:
Child One Last Name:
Child One Age:


Child Two First Name:
Child Two Last Name:
Child Two Age:


Child Three First Name:
Child Three Last Name:
Child Three Age:


I require special accommodations under the Americans with Disabilities Act (ADA). Please call the DASA Office at (305 579-0092).