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

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download