Pit & Quarry, February 2016

ATTENDEE REGISTRATION FORM Advance Deadline through January 29 2016 I REGISTRANT INFORMATION One registrant per form News Media should use Media Registration Form ___________________________________ First Name Online www agg1 org AGG1 World of Asphalt Registration 9696 South 500 West Sandy UT 84070 ____________________________________________________________________________ Company Organization Fax 1 801 406 0660 Customer Service 1 801 676 7952 ____________________________________________ Source Code from mailer ad email state etc __________________________________________________________________________________________________________________________ Address ___________________________________ City ___________________________________ Country _____________________________________________________ Email required for automated email confirmation II DEMOGRAPHIC INFORMATION _______________________________________ Last Name _______________________________________ State Province _______________________________________ Telephone Mobile Phone Fax Non industry Guest Child Age_____ If either box is checked you are not required to answer remaining demographic questions in Section II Job Title B01 President Owner B02 VP General Manager CFO B03 Purchasing B04 Marketing Sales Mgmt B05 Project Manager B06 Equipment Fleet Mgr A05 AGG1 Aggregates Academy Expo A06 Both Shows Type of Business Fill out only 1 of the 6 sections below F101 Contractor Check all that apply F07 Excavating Earthmoving Grading F09 Paving Maint Hwy Airport F10 Paving Maint Parking Lot Driveway Recr F13 Paving Hwy Airport F102 Producer Check all that apply F35A Crushed Stone F35B Sand Gravel F35C Pulverized Minerals F36 Ready Mixed Concrete F14 Paving Parking Lot Driveway Recr F19 Rock Drilling Blasting F41 Hot Warm Mix Asphalt F44 Oil F46 Asphalt Additives F47 Asphalt Liquid Asphalt F28 Recycling Reclaiming III REGISTRATION AND EDUCATION FEES ____________________________________________ Title ____________________________________________ Zip Postal Code ___________________________________________ __________________________________________________________________ B16 Estimating B17 Foreman Superintendent B18 Equipment Operator B19 Maintenance Mechanic Number of Employees C01 10 or less C02 11 50 C03 51 100 C04 101 250 F105 Dealer Distributor Rental Manuf non exhibiting company Check all that apply F80 Equipment Dealer F85 Equipment Rental F86 Equipment Manufacturer F106 Other F95 Association F104 Designer Specifier Consultant Services Check all that apply F70 Design Engineer F71 Consulting Engineer F73 Consultant Prof Services F74 Computer Information Tech F75 Material Testing F76 Leasing Finance Advance Standard Total Through 1 29 2016 After 1 29 2016 _______________________________________ Age if under 40 F103 Public Sector Check all that apply F50 Federal state F51 Provincial local 2016 Show Badge Exhibits Only show badge required to purchase tickets seminar or tour 50 70 _______________ 3 Session Pass includes entrance to 3 sessions and show badge 275 315 _______________ Full Conference Pass includes unlimited entrance to sessions opening celebration and show badge 570 620 _______________ Single Session Tickets may purchase multiple tickets ______ 90 ea ______ 95 ea _______________ AGG1 Academy Education Sessions and People Plants Paving Training Sessions Sessions purchased will be valid for any date or time slot taking place for either program No Pre Selection of sessions required Sessions are nontransferable The chip in your badge will be embedded with all education purchases All badges will be scanned prior to classroom entry For more information on schedule dates times and classes being offered refer to brochure or online at www agg1 org Total Amount Due ___________________ V PAYMENT INFORMATION All registrations must be accompanied with payment in full Payable in U S funds only Check No _____________________ payable to AGG1 NSSGA Convention Credit Card Number ________________________________________________________ Security Code ________ Expiration Date ________ _________ _________ Name on Credit Card ________________________________________________________ Signature ______________________________________________________ If billing address is different from above enter here ____________________________________________________________________________________________________________________ PLEASE NOTE Charges will appear on your statement as AGG1 NSSGA Convention MasterCard VISA American Express For a complete list of all registration policies show information go to www nssga org My primary show interest is check only one A04 World of Asphalt Show Conference B08 Environmental Mgr B13 Plant Facilities Mgr Answer all questions Incomplete forms will not be processed B07 Technical Engineering Safety Mgr Must Choose One CO LOCATED WITH C05 251 500 C06 501 1000 C07 1001 or more Additional Seminar Tour Options Rogers Group Inc s Rutherford Quarry Operations Tour March 21 11 00 a m 2 00 p m 50 60 _______________ Opening Celebration Concert March 21 7 00 10 00 p m 75 75 _______________ The NSSGA Experience March 21 4 30 10 00 p m March 22 8 00 9 00 a m March 23 7 00 10 00 a m 295 295 _______________ Young Leaders Luncheon March 22 Noon 1 00 p m Attendees aged 40 and under Free Free _______________ Basic Supervisory Training March 23 1 00 6 00 p m March 24 7 30 a m 3 30 p m 749 799 _______________ Strategic Sales Training March 23 1 00 6 00 pm March 24 7 30 a m 3 30 p m 749 799 _______________