Niba

Connecting Companies with Funding and Liquidity Sources Since 1982.

 
 
 

REGISTRATION FORM

Thank you for registering for the upcoming NIBA Capital Conference. We look forward to having you join us at the Conference.  Please note that conference registration cancellations received 10 days prior to the conference will be credited to a future attendance. Attendees who cancel within 10 days of the conference will receive a credit that may only be applied to the next scheduled conference.  Registration fees must be paid in full prior to the conference.


Download & Fill Out the registration form
(Registrations must be received via FAX or EMAIL)

Click Here to Download Application
(Hollywood, Florida Attendee Registration Form)

Please fax registration forms to 706-208-1033, mail to P.O. BOX 6625, Athens, GA  30604,
or email to emily@nibanet.org.

Or you can also fill out the form below to register

Personal Information: (please, only one attendee per form) * required fields
* Name: * Title:
* Company: Website:
* Address: * Email:
* City: * Correspondence: Email Fax
* Country/
State:		 * Phone:
* ZIP: Fax:
NIBA Conference Registration Fee Structure
 Select the pricing option below that applies to you:
* NIBA Member Broker Dealers
    (For NIBA Members/Associate Members Only)		   $150.00 Yes No
* First-time NIBA Conference Attendee (Broker Dealers Only)   $0.00 Yes No
* First-time NIBA Conference Attendee (Non-Broker Dealer)   $175.00 Yes No
* NIBA Associate Members
    (For NIBA Members/Associate Members Only)		   $350.00 Yes No
* Spouse/Companion Registration
     (This price does not apply to company personnel)		   $100.00 Yes No
* VENDOR REGISTRATION FEE
    (This includes 6ft. skirted display table and 2 Co. Reps)		   $1,500.00 Yes No
Conference Registration Payment Method:
* Charge My: VISA     MasterCard     American Express     
Please register me for NIBA Golf Outing? Yes No, Thanks
Do you need hotel reservation? Yes     No, Thanks
Hotel Reservation:
* Room Type:
Single Deluxe Room -139.00 Double Deluxe Room -$139.00
Please call NIBA @ 706-208-1033 for Suite Availability, Thank You.
* Arrival Date: * Departure Date:
Sharing with: Hotel Reward Number:
Special Needs/
Accommodations:

(ONLY ROOMS RESERVED THROUGH NIBA WILL BE GUARANTEED AT THIS ROOM BLOCK RATE).
Please fax your registration form to the NIBA Office at 706-208-1033.

Hard Rock Hotel & Casino 1 Seminole Way, Hollywood, Florida 33314
www.seminolehardrockhollywood.com
Do you want NIBA Polo T-Shirt? Yes     No, Thanks
Do you want to receive NIBA newsletter updates? Yes     No, Thanks
Do you have promotional code? Enter it now:

I understand all guaranteed reservations will be held until 6:00AM the following day. I understand that I am liable for one night's room deposit and tax (which will be deducted from my deposit or billed through my credit card) in the event that I do not arrive or cancel 72 business hours prior to the arrival date indicated.

Note: NIBA discourages conference participants from hosting activities that conflict with events scheduled by NIBA.


©Copyright 2010 National Investment Banking Association.