This form is to be completed by the Treasurer or Agent of the County ECA.  It asks for general information about the  county delegation. Your ECA will not be officially registered until this form is completed and the registration payment is received.

"Early Bird” registration is $15 per person. The last day to qualify as “early bird” is April 1st. The fee after April 1st is $20 per person.  The final deadline to register and PAY is April 12.  If payments are postmarked after April 1st, the full $20 registration fee is expected.  There are NO refunds/cancellations after April 1st  because the registration funds will be committed to plan a quality conference  experience.

Delegate substitutions are allowed.  When making a delegate substitution, call 336-953-3143.

After all information has been entered into the form, and the form has been "submitted" an e-mail confirmation will be sent to the e-mail address that was provided on the form.  Print out a copy of this "confirmation" and submit it with the registration payment. (see below for payment details)

Make checks payable to: North Central ECA. Individuals should submit their payment to their county treasurer or agent.  County Treasurers/Agents  should submit 1 check  for the total amount of their delegation’s registration.  Registration payments AND  a copy of the registration e-mail confirmation should be mailed to:

                                                            Mary Nell Richie,
                                                            351 Richie Road
                                                            Mocksville, NC   27028