Collector - June 2010

2010 CONVENTION REGISTRATION FORM

ACA’s 71st Annual Convention & Expo • July 11-14, 2010

Gaylord National on the Potomac • Washington, D.C.

Complete one form per person. Complete as you would like your badge to appear.

First Name________________________________________ Last Name __________________________________________ Name for Badge ____________________________________ Member Number _____________________________________ Company _________________________________________ Title _______________________________________________ Mailing Address__________________________________________________________________________________________ City_____________________________________________ State ___________________ ZIP/Postal Code ___________ Country __________________________________________ E-mail (required) ______________________________________ Telephone ________________________________________ Fax _______________________________________________

 This is my first ACA Convention.
ACA Convention Registration Fees
ACA Convention Registration

Early Bird (By 5/14)

 776  660  589  466

Regular (5/15-6/14)

 862  733  648  518

Late (On/After 6/15)

 949  807  713  569

 1,164  698

 1,293  776

 1,423  854

President’s Banquet: Tuesday, July 13

 Yes, I am attending the President’s Banquet.  No, I will not be attending. Any changes to this section must be made by June 28. The deadline to receive a ticket for this event is June 28. FOR CONVENTION ATTENDEES ONLY. THIS FORM CANNOT BE PROCESSED WITHOUT COMPLETING THIS SECTION.

Legislative Day: Wednesday, July 14

 Yes, I plan to attend Ask Doctor Debt Makes a House (and Senate) Call.

FREE Campus ACA Seminar: Collection Floor Management: Sunday, July 11

 Register me. (Space is limited.)

Page 1 Total (transfer to page 2 to calculate total payment) ____________
ACA Political Action Committee (ACPAC) Authorization is hereby given to ACPAC to solicit voluntary contributions from my company’s
executive personnel for the year(s) indicated below. Authorization can be given to only one federal-level PAC affiliated with a trade association per calendar year.
Signing this form does not obligate any of my company’s executive personnel or me to contribute to ACPAC; it only means we are willing to receive ACPAC materials.
These authorizations expire on Dec. 31 of each year indicated.

2010 Signature of Officer_____________________________________

2011 Signature of Officer_____________________________________
Title ________________________ Date _______________________
Title ________________________ Date _______________________
*For purposes of voting, this person will be considered the First Person Delegate.

Mail or Fax Your Forms Today:
ACA International Convention Department, P.O. Box 390106,
Minneapolis, MN 55439-0106 • Fax: +1(952) 922-6402
Questions? Contact Campus ACA at +1(952) 926-6547.