98th Annual Conference Registration

National Tax Association
98^th ANNUAL CONFERENCE ON TAXATION * November 17-19, 2005 * Hyatt Regency, Miami, Florida

REGISTRATION FORM

1. Registration Fees (please choose one)

Mark Here	Category	Amount
___	Member	$295
___	Nonmember	$390
___	Student	$55

2. Please provide the following contact information:

Name	_____________________________________________
Affiliation	_____________________________________________
Street Address	_____________________________________________
City / State/ Zip	_____________________________________________
Work Phone	_____________________________________________
FAX	_____________________________________________
E-mail	_____________________________________________

3. Are you currently a member of NTA?

Mark Here
___	Yes
___	No

4. How would you like to pay?

Mark Here	Category
____	Check (Payable to National Tax Association)
____	Voucher (please send a copy of the approved form)
____	Purchase Order (please send a copy of the approved form)
____	Invoice Company/Agency
____	VISA/Master Card (sorry, we do not accept American Express)

For credit Card Payments:
Card Type: Master Card: ___ VISA:___
Acct. No: ______________________________________ Expiration Date Mo:______   Year: _______
Name On Card: _______________________________________________________
Name of the member (if different from above) __________________________
Amount: ___________________
Signature

(Confirmation on request)

Register by Mail/Fax
Annual Conference on Taxation
National Tax Association
725 15^th Street NW #600
Washington DC 20005-2109
FAX 202/737-7308 - for credit card payments (VISA or MasterCard only)

Please register before November 1, 2005. Cancellations will be refunded minus a $25 service fee until October 11 and at half of the registration fee until November 4. No refunds for cancellations after November 5.

Last revised: August 23, 2005