Pub. 1 2022 Issue 3

Firm___________________________________________________________ Address_____________________________________________________ City/State/Postal Code __________________________________________ Country _____________________________________________________ Telephone _____________________________________________________ Fax_________________________________________________________ Registrant Name __________________________________________ Badge Name ________________________NFDA ID # ___________________ Email _________________________________________________ q Opt-out from vendor emails Cell (used for onsite updates) _______________________ Unique email required for confirmation, badge printing and event app License #/State ___________________________ License #/State_____________________________ Academy # _____________________________ Registrant Name __________________________________________ Badge Name ________________________NFDA ID # ___________________ Email _________________________________________________ q Opt-out from vendor emails Cell (used for onsite updates) _______________________ Unique email required for confirmation, badge printing and event app Please list any special accommodations needed __________________________________________________________________________________ Is this your first NFDA Convention? q Yes q No International Convention & Expo October 12-15, 2014 Nashville, TN Method of Payment q Check (U.S. dollars drawn on U.S. bank) payable to NFDA, 13625 Bishop’s Drive, Brookfield, WI 53005-6607 q Credit Card: Fax to +1.262.789.6977 or call your personal NFDA member services representative at 800.228.6332 or +1.262.789.1880. q Amex q MC q VISA q Discover Card Number_________________________________ Expiration Date_________ CVV_______ Name on Card (please print) ________________________________________________________________________________________________ Cardholder’s Signature _____________________________________________________________________________________________________ Cancellations for the 2022 NFDA International Convention & Expo registration and/or special events must be received in writing and faxed or postmarked on or before September 23, 2022, to receive a full refund. Cancellations received after September 23, 2022, and before October 5, 2022, will be refunded the registration fee minus a $75 cancellation fee; special event fees/tickets will not be refunded. Cancellations received on or after October 5, 2022, and no-shows will not receive a refund. Telephone requests must be followed up in writing. 2022 NFDA International Convention & Expo Registration Form Baltimore, MD • October 9-12, 2022 nfda.org/convention • 800.228.6332 • +1.262.789.1880 Must be Received by Sept. 27, 2022 1st Registrant Additional Registrant Student Expo Continuing Education Credit 4 4 — — Workshops 4 4 4 — General Sessions 4 4 4 — Welcome Party 4 4 4 — Expo Hall 4 4 4 4 NFDA Member Fee On or before Sept. 1 $590 $285 $65 $160 After Sept. 1 $690 $305 $75 $170 Non-Member Fee On or before Sept. 1 $890 $385 $85 $320 After Sept. 1 $990 $405 $95 $335 Total for Your Selection $ $ $ $ Grand Total $ Group Discounts: Call 800.228.6332 or +1.262.789.1880 for groups of five or more from the same firm. Suppliers/ Distributors: Contact Business Development at bizex@nfda.org or 800.228.6332. Preconvention Seminars: Visit nfda.org/ preconvention or call 800.228.6332 or +1.262.789.1880 for Certified Celebrant Training, Arranger Training, Cremation Certification and Extreme Restoration Case Solutions, “What to Do and Use.” Extras Fee Quantity Total Saturday: Dover Orientation (18 & over) 7 a.m. Bus Fee* $40 Saturday: Dover Orientation (18 & over) 10 a.m. Bus Fee* $40 Tuesday: Funeral Directors Under 40 Party at Kraken Axes $60 Wednesday: Closing Party at National Aquarium Adult $100 (2 and under are FREE) Ages 3 to 12 $50 Total for Your Extras $ * You can only pick one Dover Orientation option. Background check required. You will receive a separate email with an information request form. You must fill it out in order to be considered for the Dover Orientation. You must pass the background check in order to attend; acceptance is not guaranteed. Contributions Total Please accept my NFDA PAC Contribution (Voluntary) $ Pub. 1 Issue 3, 2022 29

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