Northern Exposure presents

REGISTRATION FORM Follows below the announcement

NORTHERN EXPOSURE hosting NANCY MICKLE-EMMERICH is around the corner - NOVEMBER 11TH in SHREVEPORT. Nancy will be speaking on Seniors and Photoshop.

Please complete the attached registration form and fax or mail it in at your earliest convenience. Visit our website at www.ppla.net for more details on Northern Exposure and to view the photographers and results from State Convention.

www.ppla.net

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NORTHERN EXPOSURE – NOVEMBER 11, 2007

• In order to attend Northern Exposure, you do not have to be a PPLA member.

• Please fill out a separate registration form for each person attending .

• Please submit registration via Mail (109 North Patton Street, Marksville, LA 71351) or Fax (318-253-8661)

Name: _____________________________________________________________________________

Studio Name: _______________________________________________________________________

Address: ___________________________________________________________________________

City: ______________________________________ State:___________________ Zip:____________

Parish: _____________________ E-Mail Address: _________________________________________

Telephone Numbers: Studio ________________________________ Work______________________

Fax:__________________________________

Home _____________________

REGISTRATION FEES:

*** Please circle your classification

PPLA Members PPA Members Non-PPLA Members

Registration Prior to November 9th $50.00 $ 75.00 $100.00

At the Door $75.00 $100.00 $125.00

TOTAL DUE………………………...$______________

Payment Type _______ Check ______ Credit Card

Credit Card Information: (Circle One) Visa Mastercard Discover American Express

Name on Account: ___________________________________________________________________

Account #__________________________________________________________________________

Expiration Date: ______________________ Amount to be Charged: $________________________

Signature: _____________________________________________________________

Professional Photographers of Louisiana, Inc., 109 North Patton Street, Marksville, LA 71351
318-359-6633 Fax 318- 253-8661

www.ppla.net