Date/Time:
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R E G I S T R A T I O N
Thank you for your interest in attending the Process Education Conference 2021.
To reserve your place, please fill out the information below.
First Name
*
Last Name
*
Email Address
*
Title/Department
School/Affiliation
*
Phone number
*
Address 1
*
City
*
State
*
Postal Code
*
Photo & Video Release:
Videos, stills, and screen shots may be taken during the conference to be used for purposes such as Academy membership brochures, the Academy website, etc. If you object to your image being used for these purposes, please indicate NO, here.
*
Yes, you may use my image.
No
If someone recruited you to attend this conference, please tell us who!
Conference
Note that you will have the opportunity to pay online (credit or debit card,
processed through PayPal) or by check once you have completed this form.
Conference Registration (All 3 days)
Price $140.00
Conference Registration (THURSDAY June 24 only)
Price $70.00
Conference Registration (FRIDAY June 25 only)
Price $70.00
Conference Registration (SATURDAY June 26 only)
Price $70.00
Calculate total:
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Comments/Questions
Did you attend last years conference?
Yes
No