Assembly on Federal Issues and the
Assembly on State Issues Joint Meeting
Fiscal Chairs Seminar

Registration Form C

December 5-7, 2001
Washington, D.C.

Name________________________________________________________________________

Title__________________________________________________________________________

Affiliation_____________________________________________________________________

Address_______________________________________________________________________

City_______________________________________State________________Zip____________

Phone_____________________________________Fax_________________________________

E-mail_____________________________________

Spouse/Guest Name_______________________________________________________________

First time I've attended__________

Fees: (Please circle one) Note: On-line registration is not available for participants wanting to attend both the AFI/ASI meeting and the Fiscal Chairs Seminar. Please complete this registration form and mail or fax it to NCSL.

$385	State Legislator, Legislative Staff
$415	City, county, state, federal, university, tribal representatives and nonprofit organizations (budgets less than $1 million)
$495	Foundation for State Legislatures and nonprofit organizations (budgets over $1 million)
$560	All others
$135	Guests

Will be attending the pre-conference seminar: (No charge)

__ Children's Environmental Health
__ Driver Focus and Technology Forum
__ The 21^st Century Student: Skills for the New Economy

Fiscal Chairs Seminar - December 7-8, 2001 (circle one)

$225	State legislator, legislative staff
$255	City, county, state, federal, university, tribal representatives, union and small nonprofit organizations (budgets less than $1 million)
$335	Foundation for State Legislatures and large nonprofit organizations (budgets over $1 million)
$400	All others
$80	Guests

Combined fee for AFI/ASI and Fiscal Chairs Seminar, December 5-8, 2001 (circle one)

$495	State legislator, legislative staff
$525	City, county, state, federal, university, tribal representatives, union and small nonprofit organizations (budgets less than $1 million)
$605	Foundation for State Legislatures and large nonprofit organizations (budgets over $1 million)
$670	All others
$175	Guests

Special Needs_______________________________________________________________

Payment Method (Please circle one)

Check enclosed	Pay on site	Bill to State Voucher/ Purchase order No. _______
Visa	MasterCard	American Express
Diners Club

Credit card number____________________________________________Exp. Date_________

Signature_______________________________________________________

Registration fees are payable in advance or on site.
To preregister, please complete this form and mail or fax by November 21, 2001, to:

NCSL Registration
P.O. Box 17972
Denver, Colorado 80217
(303) 830-2200; FAX (303) 860-8057

Assembly on Federal Issues and the Assembly on State Issues Joint Meeting Fiscal Chairs Seminar

Registration Form C

Fiscal Chairs Seminar - December 7-8, 2001 (circle one)

Combined fee for AFI/ASI and Fiscal Chairs Seminar, December 5-8, 2001 (circle one)

Assembly on Federal Issues and the
Assembly on State Issues Joint Meeting
Fiscal Chairs Seminar