American Association of State Highway and Transportation ...
2019 Transportation Symposium and RSVP for Spring Forum
Sleeping Rooms – Sheraton Downtown Austin, TX April 11-12, 2019 –
Austin, TX - (512) 693-7500 ph.
Please print clearly.
First Name: Last Name: _______
Nametag/Nickname: Chapter #________ SR/WA Yes ______ No _______
Agency/Company:
Address:
City: State: Zip:
Phone: Fax: E-Mail:
Designations: __R/W-AC, __R/W-AMC, __R/W-EC, __R/W-NAC, __R/W-RAC, __R/W-UAC
TRANSPORTATION SYMPOSIUM April 11, 2019 - REGISTRATION FEE - Includes: Breakfast, A.M. Break, Lunch, P.M. Break, Reception, Audio Visual equipment and support and admittance into all meetings and materials.
O Government Employee $200 Early, $250 Late – After March 2, 2019
O Private Industry $300 Early, $350 Late – After March 2, 2019
No Refunds After March 31, 2019, Substitutions Are Encouraged, All Refunds Incur $25 Processing Fee
( I would like to RSVP for the Spring Forum – April 12, 2019 NO FEE (ALL PARKING IS SELF or Valet)
PAYMENT INFORMATION - (Housman & Associates Tax ID# 20-0895486) Make Checks Payable to Housman and Associates
Check Number: ( Visa ( Discover ( MasterCard ( American Express
For TxDOT Employees: Card Number:_______________________________________
Finance Rep:____________________________ Expiration Date:
Housman and Associates will invoice thru Security Code:______________________________________
Texas DOT Financial Rep Name on Card: ________
Full Address CC bill comes to:___________________________
Total Registration Fees: $ _____________
For payment by check or TxDOT
Make checks payable to Housman and Associates
Mail completed form to:
Housman & Associates
1309 Pasa Tiempo
Leander, TX 78641
For credit card payment ONLY
Fax completed form to:
Housman & Associates
(512) 259-5571
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