Official Registration Form

2013 Conference, July 18-21, Phoenix-Tempe

Mission Palms Hotel and Conference Center, www. missionpalms.com

Attendee Name: _______________________________________________________________________________

Email Address: ______________________________ Phone Number: ___________________________________
Mailing Address: ______________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Job and Company (optional; info entered will be included on conference badge):
____________________________________________________________________________________________
Twitter handle (optional): _______________________________________________________________________
Website or blog URL (optional): __________________________________________________________________
Tribal Affiliation (optional): ______________________________________________________________________

Registration rates (choose one): All registrations must be postmarked by their deadline date to be accepted.

Student Rates:

General Registration Rates:

$110 -- Deadline: April 1, 2013

$265 -- Deadline: April 1, 2013

$160 -- Deadline: May 31, 2013

$350 -- Deadline: May 31, 2013

$210 -- Deadline: ON-SITE

$450 -- Deadline: ON-SITE

NAJA Member Rates:

$210 -- Deadline: April 1, 2013
$310 Deadline: May 31, 2013

$375 -- Deadline: ONSITE

Official Registration Form

National Native Media Conference, July 18-21, 2013
Mission Palms Hotel and Conference Center, Tempe, Ariz., www. missionpalms.com

NAJA Membership:
You must be a member of NAJA at the time of registration to receive the member rate. If you are a new
member, your membership application and fee must accompany registration if it has not already been
processed. All media professionals interested in increasing and improving news and communication
access in Indian Country are encouraged to join NAJA. For more information, visit www.naja.com/
membership.
Deadline for registrations sent by mail:
ALL registration forms sent by mail must be postmarked and mailed to the NAJA office by July 5,
2013, as the office will be closed in preparation for the conference and no one will be available to
process mailed registrations after that date. After July 5, you must either register online or register onsite at the conference.
Hotel:
As you register, remember to also book your room at our host hotel, the Mission Palms Hotel; 60 E. 5th
St., Tempe, AZ 85281. Call 1-800-547-8705 to make reservations. NAJA has secured a room rate for attendees
of $80 per night before taxes and fees.

Will you be attending any or each of the following meals/special events? Please mark all that apply:
NAJA-NPM Opening Reception (July 18): ____
NAJA Member Meeting (July 21): _____

NAJA-NPM Media Awards Banquet (July 20): _____

Student Reception (July 19): _____

Do you have any special needs or menu requirements you would like NAJA and NPM staff to be aware of?
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________

PAYMENT FORM:
Billing Information
CHECK CREDIT CARD (Circle): AMEX | Visa | Mastercard
TOTAL: _________________
Credit Card Number (if paying by credit card): __________________________________________________
Expiration Date: __________________________ Security Code: ____________________________________
Cardholder Name: ___________________________________________________________________________
Billing address:______________________________________________________________________________
____________________________________________________________________________________________
_____________________________________________________________________________________________

_____________________________________________________________________________________________

I, ______________________________________________________________________, agree to pay the above amount,

according to the card issuer agreement.

_____________________________________________________________________

________________

Signature

Date

Thank you! We look forward to seeing you in July. Please send your completed registration form and
payment via mail, fax or email to:
NAJA-NPM Conference Registration
c/o Native American Journalists Association
Gaylord College at University of Oklahoma
395 E. Lindsey Street
Norman, OK
P: 405-325-9008 F:405-325-6945
Email: pamsilas@naja.com