STA CONFERENCE REGISTRATION

Download a printable registration form.

Yes, sign me up to attend the "2011 STA Annual Conference" from October18-21, 2011!

*First Name:

*Last Name:

Company Name:

*Address:

*City:

*State:

*Zip:

*Phone:

( ) -

Fax:

( ) -

*Email:

* Is this your first STA Conference: YES NO

*Indicates a required field.

My company WILL or WILL NOT be donating a "handout" gift and/or door prize.
(Please complete the Conference Donations Form as soon as possible.)

Please list the name of attendees as you want them to appear on the conference badges:

First Name:
Last Name:

Guest First Name:
Guest Last Name:

Total number of people attending:

I WILL BE PARTICIPATING IN THE FOLLOWING ACTIVITIES:

# OF PEOPLE		# OF PEOPLE
	Tuesday, October 18th Reception and Dinner		Thursday, October 20th Open Forum
	Wednesday, October19th Golf Tournament* *If you register for golf your room or credit card will be billed for the tournament fee		Thursday, October 20th Luncheon with Vendor Exhibits**
	Wednesday, October 19th Small Agent's Training		Thursday, October 20th Theme Night Buffet Dinner & Dancing
	Thursday, October 20th Small Agent's Forum

*Please complete the "Golf Registration Form"
**Vendor Exhibitors please contact the STA.

CONFERENCE FEES:

Conference Participant from member Company*	@ $595.00 ea
Conference Participant from non-member Company*	@ $745.00 ea
Discount: Conference Participant* (2 or more from same Company)* deduct	@ -$50.00 ea
Golf	@ $60.00 ea
Club Rental	@ $55.00 ea
Vendor Table (FREE for Conference Sponsors)	@ $1,500.00 ea
Total	$0

*(includes one spouse/guest - additional attendees from the same company are not considered guests)

Please mail with check or money order made payable to the STA by September 16th to:

Carol Gaffney
The Securities Transfer Association, Inc.
P.O. Box 5220
Hazlet, NJ 07730-5220

OR click “SUBMIT” below to pay by credit card.

REGISTRATION FEE:
The registration fee, which includes one spouse/guest – additional attendees from the same company are not considered guests, covers all business sessions, continental breakfast on Wednesday, Thursday and Friday, lunch on Thursday with Vendor Exhibits, STA Reception and Dinner on Tuesday and Theme Night (buffet dinner and entertainment) on Thursday. Registered spouses/guests are welcomed to attend the business sessions and evening functions.

CANCELLATIONS AND REFUNDS:
Full refund of the registration fee will be made if Carol Gaffney (732-888-6040) receives notice of cancellation by September 16, 2011. One-half of the registration fee will be refunded if requested by October 1, 2011.

After October 16th, no refunds will be made.

You must answer the security challenge
before clicking "Submit."

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