2019 Jr. NAD Conference Chapter Registration School/Chapter Name * RequiredSchool Address * Required Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code School Administrator Name * Required First Last School Phone * RequiredIs the school phone number a VP? * RequiredYesNoSchool Administrator Email * Required Jr. NAD Chapter President * Required First Last Jr. NAD Chapter Advisor(s) and email address(es) * Required(Note: Please put all advisors and their emails if there's more than one)Number of Delegates (limit 2) * Required012Number of Observers (limit 2) * Required012Number of Advisors (limit 2) * Required12How are you paying for this? * RequiredOnline via credit cardMail in checkHow many student participants ($250 each)? * Required1234How many advisors? ($300 each) * Required12Total $0.00 Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name If you're mailing a check, make it payable to 'National Association of the Deaf' with Memo: Jr. NAD Conference - (Your School) Mail certified mail to: National Association of the Deaf Attn: Chanel Bonheyo/Jr. NAD 8630 Fenton St., Suite 820 Silver Spring, MD 20910
