2010 Annual North American
AUA Users Conference

Registration Form

One form submission for each person registering

Registration Deadline: August 13, 2010

Register before July 23, 2010 to receive a $100.00 fee reduction.

*required
*Name
Name for Badge
Company
Address
City
State
 Zip
*Phone
*Email

Session Choices:

Monday, September 13
Breakout #1––11:00 AM – 12:15 PM
Breakout #2––2:45 PM – 4:00 PM

Tuesday, September 14
Breakout #3––10:45 AM – 12:00 PM
Breakout #4––3:15 PM – 4:30 PM

Wednesday, September 15
Breakout #5––9:00 AM – 10:15 AM
Breakout #6––10:30 AM – 11:45 AM
I will attend the Special Event

Attendee Conference Fees: Room nights included 9/12, 13 & 14
*Please select attendee level from pulldown menu below:
Spouse/Companion Meal Program $150.00
Child Meal Program $50.00
Triple Occupancy (Call office for pricing)
Roommate’s Name:

Additional Room Nights Required:
No. of additional nights (single/double) Indicate Dates Below
$119.00/night 9/10 9/11 9/17
$74.25/night 9/09 9/15 9/16
Total Amount Due: $
These rates include 12% taxes and are subject to change
Special rates are valid from September 9 - 17, 2010.

Method of Payment

If paying by credit card, clearly indicate your direct phone number, you will be contacted for details regarding your credit card. When paying by CHECK, make your check payable to: Cyborg Users Association.

Mail the checks and registration form only:
CUA Admin
P.O.Box 1743
Des Plaines, IL 60017-1743
*
Phone Number (if different from above) ext.

Questions?
Phone: 312-604-5015
E-Fax: 224-612-5707
E-mail: cuahq@cyborgusers.org

118 N. Clinton St., Suite 307 Chicago, IL 60661 | Ph: 312-604-5015 | Fax: 312-604-5014