Date/Time:
subject_line
Thank you for your interest in attending the Process Education Conference 2022. 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!
Attendance Options
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.
Select all that apply:
*
I plan to attend the conference in-person.
I plan to attend the conference online only.
I plan to attend the pre-conference Institute.
Select one:
*
I am a student.
I am emeritus faculty.
I am employed at VSU or a partner school.
None of the above.
The options which appear below are based on the selections you just made.
You'll need to check the box beside the option to confirm that option.
Pre-Conference Student Success Workshop
Registration for the pre-Conference Workshop ONLY
Workshop Price $150.00
Registration for the pre-Conference Workshop ONLY (Student)
Workshop Price $75.00
Registration for the pre-Conference Workshop ONLY (VSU or Partner School)
Workshop Price $100.00
Registration for the pre-Conference Workshop ONLY (Emeritus Faculty)
Workshop Price $100.00
Online Conference Participation
Registration for ONLINE Conference Participation ONLY
Online Conference Price $150.00
Registration for ONLINE Conference Participation ONLY (Student)
Online Conference Price $100.00
Registration for ONLINE Conference Participation ONLY (VSU or Partner School)
Online Conference Price $100.00
Registration for ONLINE Conference Participation ONLY (Emeritus Faculty)
Online Conference Price $100.00
In-Person Conference Participation (@VSU)
Conference (@ VSU) + Pre-Conference Workshop
Conference Registration (
earlybird pricing
BEFORE April 18)
Conference Price $325.00
Conference Registration STUDENTS (
earlybird pricing
BEFORE April 18)
Conference Price $175.00
Conference Registration
Conference Price $400.00
+ Pre-Conference Student Success Workshop
Workshop Price $75.00
Conference Registration (Student)
Conference Price $250.00
+ Pre-Conference Student Success Workshop (Student)
Workshop Price $30.00
Conference Registration (VSU or Partner School Employee)
Conference Price $150.00
+ Pre-Conference Student Success Workshop (VSU or Partner School Employee)
Workshop Price $75.00
Conference Registration (Emeritus Faculty)
Conference Price $150.00
+ Pre-Conference Student Success Workshop (Emeritus Faculty)
Workshop Price $75.00
Lodging (@ the VSU Residence Hall)
Will you need lodging at the VSU Residence Hall?
(single: $75/night, double: $50/night per person)
*
No
Yes
Type of Room
Single ($75 per night)
Double ($50 per night per person)
How many nights?
1
2
3
4
Is the other occupant also registering for the conference? (If not, you'll need to pay for both yourself and the other person.)
No
Yes (please provide their name)
Yes (please provide their name)
Lodging Cost:
75.00
Calculate
Lodging Cost:
150.00
Calculate
Lodging Cost:
225.00
Calculate
Lodging Cost:
300.00
Calculate
Lodging Cost:
100.00
Calculate
Lodging Cost:
200.00
Calculate
Lodging Cost:
300.00
Calculate
Lodging Cost:
400.00
Calculate
Lodging Cost:
50.00
Calculate
Lodging Cost:
100.00
Calculate
Lodging Cost:
150.00
Calculate
Lodging Cost:
200.00
Calculate
Total cost:
$0.00
Calculate
Comments/Questions
Did you attend last years conference?
Yes
No