Alaska School Nutrition Association's 2021 Annual Conference

Thank you for your interest in attending the AKSNA Virtual Conference.
To reserve your seat and receive log-in information please fill out the information below.

First Name *

Last Name *

Organization *

Title

Email Address *

Contact Phone Number *

Address 1 *

Address 2

City *

State *

Zip *

Include my contact information on lists distributed to vendors. *

Yes

No

Registration for the AKSNA Conference is free this year; however, donations to the AKSNA Scholarship Fund are welcome:

Total

$0.00

Names of additional attendees

	First Name	Last Name	Email Address
2nd Person	First Name	Last Name	Email Address
3rd Person	First Name	Last Name	Email Address
4th Person	First Name	Last Name	Email Address

Conference registration must be prepaid. Please either submit the registration electronically with a credit card or select "Pay by Mail".

Payment Method

	Please select one
By Credit Card (below)	Please select one
By Mail (please print this registration form and submit with check)	Please select one

Name on Card

Credit Card Type

Credit Card Number

3 Digit Code on Back of Card

Expiration Date (mm/yy)

Billing Zip Code

If registering by mail, please select continue at the bottom of the page and print the following summary, and select "submit". Mail with check to: Theresa Wilson, Lake and Peninsula School District, PO Box 498, King Salmon, AK 99613