Registration Form
2015 NACD Washington Fly-In April 28-April 29
Full Name: ____________________________________________ Nickname for Badge: __________________________________
Title: ______________________________________________________________________________________________________
Company Name: _____________________________________________________________________________________________
Company Address: ___________________________________________________________________________________________
City: ___________________________ State: ______________ Zip +4 (REQUIRED w/ plus 4): ___________________________
E-mail: __________________________________________
Cell Phone Number: [email protected]:___________________First-Time Attendee? YES/NO
Spouse/Companion Name: ____________________________________ Nickname for Badge: ______________________________
Home Address: (Needed for Congressional appointments)____________________________________________________________
City: ___________________________ State: ______________ Zip+4 (REQUIRED w/ plus 4): ____________________________
Please list any other Senators/Representatives**, in whose district(s) your company has additional facilities, with whom you would
like to meet:__________________________________________________________________________________________________
Please list any members of Congress, or staff, with whom you have a pre-existing relationship:
Please list any Fly-In attendee(s) you would like to have attend the same meetings (If possible, such as spouse, child, employees, etc.):
**Please note that Congressional offices determine meeting availability. NACD cannot guarantee meetings.
Late registrations are accepted, but make scheduling Hill meetings very difficult.
As such, it is advisable to register early.
 2015 NACD Washington Fly-In, April 28 - April 29, 2015
Includes: Briefing Materials, Congress “101” Orientation, Congressional Reception, Wednesday Breakfast, Hospitality Room, Lunch
Member Rate: $395 x____ = $______
Emerging Leader Rate: $199 x_____= $_____
Please list any dietary restrictions: __________________________________
 Please check this box if you would like to participate in meetings with key Regulatory Officials, instead of returning to the Hill on
the morning of April 29.
� American Express
� Master Card
� Visa � Check/Money Order payable to NACD enclosed
Credit Card # ________________________________________ Sec. Code: ___________Expiration Date: _______________
Card Member’s Name (Print): ________________________________Signature:______________________________________
Fax form to (703) 527-7747 or send with payment to: NACD, 1560 Wilson Blvd., Ste. 1100, Arlington, VA 22209. Fly-In cancellations must be
submitted in writing to NACD. Any cancellations received 15 business days prior to first day of event will be refunded minus an administrative
charge of 25% of the gross registration and activities fees. Any cancellations after this date will not be eligible for refunds. Substitutions can be made
at any time. No refund for no-shows.
Hotel Accommodations with group rate of $269 S/D: The Ritz-Carlton Pentagon City in Arlington, VA, 1-800-241-3333 under NACD
Washington Fly-In Room Block. Group code CADCADA. Hotel deadline is April 6, 2015.
Contact Doug Leigh at [email protected] or 571-482-3069 for questions about the Fly-In.