ATTN: NACD MEMBERS

Registration Form
2015 NACD Washington Fly-In April 28-April 29
Full Name: ____________________________________________ Nickname for Badge: __________________________________
Title: ______________________________________________________________________________________________________
Company Name: _____________________________________________________________________________________________
Company Address: ___________________________________________________________________________________________
City: ___________________________ State: ______________ Zip +4 (REQUIRED w/ plus 4): ___________________________
Phone:
Fax:
E-mail: __________________________________________
Cell Phone Number: ___________________________________Twitter@:___________________First-Time Attendee? YES/NO
Spouse/Companion Name: ____________________________________ Nickname for Badge: ______________________________
Home Address: (Needed for Congressional appointments)____________________________________________________________
City: ___________________________ State: ______________ Zip+4 (REQUIRED w/ plus 4): ____________________________
Please list any other Senators/Representatives**, in whose district(s) your company has additional facilities, with whom you would
like to meet:__________________________________________________________________________________________________
Please list any members of Congress, or staff, with whom you have a pre-existing relationship:
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Please list any Fly-In attendee(s) you would like to have attend the same meetings (If possible, such as spouse, child, employees, etc.):
____________________________________________________________________________________________________________
**Please note that Congressional offices determine meeting availability. NACD cannot guarantee meetings.
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REGISTRATION FORMS DUE APRIL 17, 2015
Late registrations are accepted, but make scheduling Hill meetings very difficult.
As such, it is advisable to register early.
_____________________________________________________________________________________________________________________________
 2015 NACD Washington Fly-In, April 28 - April 29, 2015
Includes: Briefing Materials, Congress “101” Orientation, Congressional Reception, Wednesday Breakfast, Hospitality Room, Lunch
Member Rate: $395 x____ = $______
Emerging Leader Rate: $199 x_____= $_____
Please list any dietary restrictions: __________________________________
 Please check this box if you would like to participate in meetings with key Regulatory Officials, instead of returning to the Hill on
the morning of April 29.
_____________________________________________________________________________________________________
� American Express
� Master Card
TOTAL:
� Visa � Check/Money Order payable to NACD enclosed
$______
Credit Card # ________________________________________ Sec. Code: ___________Expiration Date: _______________
Card Member’s Name (Print): ________________________________Signature:______________________________________
Fax form to (703) 527-7747 or send with payment to: NACD, 1560 Wilson Blvd., Ste. 1100, Arlington, VA 22209. Fly-In cancellations must be
submitted in writing to NACD. Any cancellations received 15 business days prior to first day of event will be refunded minus an administrative
charge of 25% of the gross registration and activities fees. Any cancellations after this date will not be eligible for refunds. Substitutions can be made
at any time. No refund for no-shows.
Hotel Accommodations with group rate of $269 S/D: The Ritz-Carlton Pentagon City in Arlington, VA, 1-800-241-3333 under NACD
Washington Fly-In Room Block. Group code CADCADA. Hotel deadline is April 6, 2015.
Contact Doug Leigh at [email protected] or 571-482-3069 for questions about the Fly-In.