Conference Registration – Arizona Trucking Association

602-850-6000 602-252-8008 info@AzTrucking.com 7500 West Madison Street, Tolleson, AZ 85353

Conference Registration

Cancellation Policy:
No Refunds after 5:00 PM, October 5.
All refunds subject to a $10.00 service fee.

Arizona Trucking Association 7500 W Madison St. Tolleson, AZ 85353
Please note: ATA cannot invoice for conference registrations.

For additional information on registration or sponsorship, contact Tony Bradley: 602-850-6005 or tbradley@aztrucking.com

Registration Details
*This information is required. One form per individual registrant/couple.

- First Name*
- Last Name*
- Company*
- Email*
- ATA Member Fee Quantity*
  Price: $59.99
  Please select how many ATA Members you are registering for. If none, then please select 0.
- Non-Member Fee Quantity*
  Price: $79.99
  Please select how many non-members you are registering for. If none, then please select 0.
- 8:30 am – 12:30 pm
  Please enter a number from 0 to 4.
  Number or people attending
- Phone*
- Names of Additional Attendees You are Paying For
- First Name
- Last Name
- Company
- Email
- First Name
- Last Name
- Company
- Email
- First Name
- Last Name
- Company
- Email
- First Name
- Last Name
- Company
- Email
- Payment Information
- Billing Address
  Street Address Address Line 2 City State ZIP Code
- Card Type
- Credit Card
  
  American Express
  Discover
  MasterCard
  Visa
  Supported Credit Cards: American Express, Discover, MasterCard, Visa
  Card Number Expiration Date Security Code Cardholder Name
- Confirm Last 4 of the Credit Card #*
- Total
  $0.00

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