NINAETC Eastern Regional Training Registration

NINAETC Eastern Regional Training Registration

Sunday, October 25- Friday, October 30, 2026 at Kingston Plantation Embassy Suites, Myrtle Beach, SC 29572
Registration Fees:

General Registration deadline: 9/30/26 - $375

On-site Registration: 10/25/26 $425

Make Checks/Money Orders to
Lumbee Regional Development Association

Attention: Natascha Tilson

P.O. Box 68

Pembroke, NC 28372
Organization and Contact Information
Organization
Organization Type
Contact Person

First NameLast Name
Contact Email
example@example.com
Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Fax Number
Please enter a valid phone number.Format: (000) 000-0000.
How many Attendee's
Attendee Details
REGISTRANT ONE

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Daytime Phone
Please enter a valid phone number.Format: (000) 000-0000.
First Time Attendee
New Director
T-Shirt Size
Dietary Restrictions (if any)
Special Accommodations Needed
REGISTRANT TWO

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
First Time Attendee
New Director
T-Shirt Size
Dietary Restrictions (if any)
Special Accommodations Needed
REGISTRANT THREE

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
First Time Attendee
New Director
T-Shirt Size
Dietary Restrictions (if any)
Special Accommodations Needed
REGISTRANT FOUR

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
First Time Attendee
New Director
T-Shirt Size
Dietary Restrictions (if any)
Special Accommodations Needed
REGISTRANT FIVE

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
First Time Attendee
New Director
T-Shirt Size
Dietary Restrictions (if any)
Special Accommodations Needed
REGISTRANT SIX

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
First Time Attendee
New Director
T-Shirt Size
Dietary Restrictions (if any)
Special Accommodations Needed
Payment Information
Payment Type
Registration Type
Total Amount to Mail In
Make payable to: Lumbee Regional Development Association Attention: Natascha Tilson Mail to - P.O. Box 68 Pembroke, NC 28372
Purchase Order Number (if Applicable)
Total Amount
Registration Fees (Paid by Credit Card)
prevnext( X )
General Registration
Deadline 9/30/26

$375.00 Attendees

Subtotal

$0.00

Tax

$0.00

Total

$0.00
Cardholder Signature

Should be Empty:

NINAETC Eastern Regional Training Registration

Organization and Contact Information

Attendee Details

Payment Information

Registration Fees (Paid by Credit Card)*

Pay with Credit Card

Registration Fees (Paid by Credit Card)