Registration Form

Please print and complete this form. Then send to UNA as noted below.

NAME ________________________________________________________________________________

TITLE ________________________________________________________________________________ 

ORGANIZATION ________________________________________________________________________

OFFICE PHONE ________________________ E-MAIL ADDRESS: ________________________________            

MAILING ADDRESS _____________________________________________________________________

_____________________________________________________________________________________
      City                                                      State                                           Zip

SEMINAR NAME:_______________________________________________________________________

SEMINAR DATE: _______________________________________

COST: _______________

___ Yes, I am a member in good standing of UNA.

___ No, I am not a UNA member.

CHOOSE PAYMENT METHOD:

___       Check - make payable to Utah Nonprofits Association

___       Please charge my:   __  AMEX        __  MasterCard        __  VISA

Account # ___________________________________________ Exp. Date ____________________________

Signature:________________________________________________        

Billing address on credit card, if different from above (include ZIP code): ____________________________________________________

___________________________________________________________________________________________

Please print name: _________________________________________

Mail or fax registration form and payment to:

Utah Nonprofits Association
175 S. Main Street, Suite 1210
Salt Lake City, UT 84111
Tel: (801) 596-1800
Fax: (801) 596-1806
Website: www.utahnonprofits.org