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21st Annual ANMAP Conference Registration Form


Name:_______________________________ Phone:____________________________________________

Address:_____________________________ City: _________________State:_________ Zip:___________

Facility:______________________________ Facility Phone:______________________________________

Facility Address:_______________________ City: ________________State:_________ Zip:____________

Position/Occupation:___________________ Email:_____________________________________________


Early bird registration (before February 15)  members $80         $__________________

                                                              non-members $130 $__________________

Regular registration (after February 15)       members $90         $__________________

                                                              non-members $140 $__________________

                               To purchase guest banquet tickets $20 each _________________

                                                                  TOTAL ENCLOSED $__________________

 

Make check payable to: ANMAP
 
Send your information and check/money to:

Shena Galla, ANMAP Treasurer

1313 Bellflower Drive, Rio Rancho, NM 87144. Ph. 505-917-5537

Complete
one form per
participant

Who Can Join?

Membership is open to educators, consultants, activity professionals coordinating programs for hospitals, adult daycare, group homes, assisted & independent living, senior centers, long term care, disabled communities and all others with an interest in the activity profession. Members join as individuals and not as facilities.Paid memberships are for one year when paid at conference, otherwise membership dues are pro-rated per month. You may either mail the $30.00 membership fee to the current Treasurer, or pay when attending the conference.


Membership Form

Name:_______________________________ Phone:______________________________

Address:_____________________________ City: _________________State:_________ Zip:___________

Facility:______________________ Facility Phone:________________

Facility Address:________________ City: ________________State:_________ Zip:____________

Position/Occupation:___________________
Email:_____________________________________

Date:________________________________


Individual Membership Dues: $30.00 annually


Make check payable to: ANMAP

Send your information and check/money to:


Shena Galla, ANMAP Treasurer

1313 Bellflower Drive, Rio Rancho, NM 87144. Ph. 505-917-5537


Complete
one form per
participant

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