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NAGAP Executive Office:
P.O. Box 14605
Lenexa, KS 66285-4605
Phone: 913.895-4616
Fax: 913.895-4652
Contact NAGAP

2012 Winter Institute for Advanced Graduate Professionals

Registration and Payment Deadline:

Members:
Early Bird Registration for Members (received by December 12th): $600
Registrations received from December 13, 2011 — January 6, 2012: $700

Non-Members:
Early Bird Registration for Non-Members (received by December 12th): $800
Registrations received from December 13, 2011 — January 6, 2012: $900

Option to include membership:
Early Bird Registration (received by December 12th)
Individual Membership & Registration: $750

Registrations received from December 13 — January 6, 2012:
Individual Membership & Registration: $850

Register Now and pay later via Credit Card or Check

Please fill out this form to register
Select Registration Type:	New Individual Current Member Non Member
NAGAP ID Number:
First Name:
Last Name:
Title:
Name of Institution:
Address 1:
Address 2:
City:
State:
Country:
Zip:
Phone:
Fax:
Email:

Please indicate how you would like your name to appear on your name tag:
How long have you been in your current position?
Institution Type: Public Private Proprietary Not a School (affiliate member) Not Applicable
Please indicate the type of graduate programs for which you are responsible: (Please check only one) Arts & Sciences/Fine Arts Business/Management Communications/Journalism Education Law Medicine/Biomedical Science Science/Health Professionals Social Work/Public Health/Public Services Technology/Engineering Architecture Theology Urban/Public Affairs Multiple Disciplines Other Not Applicable
Please estimate the total number of students in the graduate program(s) at your institution: Less than 500 501-999 1000-2499 2500-4900 5000 or more Not Applicable