DO NOT USE THIS FORM! Housing options have changed; there are no more rooms available on campus. If you need housing and have not registered yet, you'll need to make arrangements for a hotel (check the "Lodging" page on the PE Conference site). Please use the registration link available HERE instead. Thank you!

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

Do you have any special dietary needs? (select one)

Vegetarian

Vegan

Gluten Free

Please note that you'll be able to see

an order overview on the next page

BEFORE submitting your information!

Conference and/or Workshop Total:

$0.00

Lodging (@ the VSU Residence Hall)

Will you need lodging at the VSU Residence Hall?
(single: $85/night) (double: $50/night per person) *

No

Yes

Type of Room *

Single

Double

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)

How many nights? (single room) *

1 ($85)

2 ($170)

3 ($255)

4 ($340)

How many nights? (double room, paying separately) *

1 ($50)

2 ($100)

3 ($150)

4 ($200)

How many nights? (double room; this person paying) *

1 ($100)

2 ($200)

3 ($300)

4 ($400)

What is your arrival date? *

Sunday May 22

Monday May 23

Tuesday May 24

Wednesday May 25

Please note that you'll be able to see

an order overview on the next page

BEFORE submitting your information!

Lodging Total:

0.00

Lodging Total:

0.00

Lodging Total:

0.00

Comments/Questions

Did you attend last year's conference?

Yes

No