Filipino American National Historical Society

14th NATIONAL CONFERENCE

June 28-30, 2012 Marriott Hotel 2101 Louisiana Boulevard NE, Albuquerque, NM 87110 (505) 881-6800)

CONFERENCE REGISTRATION
Postmarked by May 25th, 2012 Sent After May 26th, 2012

FANHS Member Senior Member (62 and over) Student Member Non-Member / Regular Non-Member / Students & Seniors

$100.00 $ 90.00 $ 90.00 $140.00 $110.00

$120.00 $100.00 $100.00 $150.00 $120.00

Full Registration includes conference sessions / Thursday continental breakfast and Authors Reception / Friday breakfast, box lunch and membership meeting snack / Saturday - evening banquet. One-Day Regisration includes sessions and meal for the day but not Saturday Gala Banquet: Members $ 40.00 Non-Members $ 50.00 Members: Students and Seniors $ 30.00 Non-Members: Sr/St $ 40.00 Gala Banquet Only: $40.00 per person Historic Tours: (Wed. 6/27/2012) - tentative fee w/lunch - $35 / Space is limited

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Please print

Mr/Mrs/Ms/Dr. Last Name _________________________ First Name__________________ Middle Initial ________ Chapter / Organization / Institution _________________________________________________________________ Address __________________________________________ City __________________State _____ Zip _______ Home Phone ____________Work Phone _____________email __________________________ fax____________

Are you a FANHS member? (check one)

__ Yes ___ No __ No, but I wish to join at this time

Current membership? (check where applicable)

__ Yes ___ No, but I wish to renew my membership __ Chapter Name __________________________________ __ At-large member

FANHS Membership
Individual Family Student or Senior Conference Registration Banquet Only Tour Fee Membership Fee Total Enclosed

Annual $30.00 $40.00 $10.00 $ ________ $ ________ $ ________ $ ________ $ ________

10/years $150.00 $250.00

Lifetime $300.00 $350.00

___ Credit Card:

___ Visa

___ Master Card

___ Discover ___ AmEx Card # ________________________ Exp. Date_____

Mail forms and checks/money orders to Rio Grande FANHS / PO Box 80241 Albuquerque, NM 87198, or register on-line: http://riograndefanhs.org/14thBiennialNationalConference.aspx th Early registration/payments must be postmarked by May 25 , 2012. Mailed registrations will be accepted by office until June 20, 2012. Later registrations will be on-site. Please do not send cash.