Convention Registration Form

Convention Registration Form

Name of Member_________________________________________________________
Mailing Address__________________________________________________________
City__________________________________ State___________________ Zip_________________
Phone (day) (_____)_________ (evening) (_____)__________ e-mail_____________
NTA Membership #______________ (Your NTA # is important if you are interested in NTA Certifications or NTA Award of Excellence Programs)
*Arkansas is no longer an affiliate state of the NTA. If you want to be a NTA member you will be responsible for your dues with them*
Spouse/Guests’ names (if attending convention)_________________________________
-for nametags

CATEGORY PRICE TOTAL
(circle one)
I am paying my ATA membership dues at this time

OR

I have already paid my 2016 ATA dues
$50.00 $60
Individual Business
$0 $__________
Convention Registration – ATA Member
*annual ATA membership dues must also be paid
**if MEMBER is a business, employees attending convention do not pay membership fee but must pay individual convention registration fees OR

I am unable to attend the convention this year $50.00 X ________
# of employees
(if a business)
$0 $__________
Convention Registration – Out of State *All registrants must be a member of their respective state OR the N.T.A. and must furnish proof of membership at the time of check-in $60.00 $__________
Qty
_____ _____ _____ _____
_____ Competition Entry Fees- Mounts (inc. judged Pres Ch) Competition Entry Fees- Habitats Best All Around Category Competitors Award
Journeyman Award
$15.00 each mount $15.00 each habitat $25.00 entry fee $25.00 entry fee
$25.00 entry fee $__________ $__________ $__________ $__________
$__________
_____ President’s Challenge (Squirrel- pedestal or life-size) $0.00 (if not judged & eligible for
President’s Challenge award ONLY) __________
TOTAL AMOUNT DUE (make check payable to A.T.A) $ _________

Remember: Pre-registering saves time and enters you into a special drawing for a doorprize. You can pre-register even if you are unsure how many mounts (if any) you will bring. If you are not pre-registering, please remember that we are unable to accept debit or credit cards at the show- ONLY CASH OR CHECKS. Sorry for any inconvenience.

Mail Registration & Check To:
Arkansas Taxidermist Assn.
C/O Lisa Huggs
138 Trapper Lane
Hot Springs, AR 71913