Elementary Mini-Conference Registration 2023 NCMEA Elementary Mini-Conference Registration Name(Required) First Last Billing Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone(Required)Email(Required) School District(Required) School Name(Required) Member of NAfME/NCMEA?(Required) Yes No NAfME Membership Number(Required)Registration Options (pick one)(Required)In-person NCMEA member - $40In-person non-member - $45Virtual NCMEA member - $30Virtual non-member - $35College student, no lunch - $0College student, with lunch - $10Total Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Security Code Cardholder Name Lunch Options (pick one)The Pepe - ham, provolone, lettuce, tomato, mayoBig John - roast beef, lettuce, tomato, mayoTotally Tuna - tuna salad, cucumber, lettuce, tomatoTurkey Tom - turkey, lettuce, tomato, mayoThe Vito - salami, capocollo, provolone, onion, lettuce, tomato, oil & vinegar, oregano & basilThe Veggie- provolone, avocado spread, cucumber, lettuce, tomato, mayoNo LunchLunch Customizations/RestrictionsPlease provide any details we need to know when placing your lunch order (ie. Gluten free, no mayo, etc.).
