Date/Time:
subject_line
Thank you for your interest in attending the Process Education Conference 2023.
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.
Registration prices increase by $25 after May 5.
Is this an individual or group registration?
*
INDIVIDUAL
GROUP
INDIVIDUAL
Conference Registration (
earlybird pricing
BEFORE May 5)
Price $125.00
INDIVIDUAL
Conference Registration (
normal pricing
AFTER May 5)
Price $150.00
STUDENT
Conference Registration (
earlybird pricing
BEFORE May 5)
Price $60.00
STUDENT
Conference Registration (
normal pricing
AFTER May 5)
Price $85.00
How many individuals are part of your group registration? (
earlybird pricing
BEFORE May 5: $100/person)
3 individuals
4 individuals
5 individuals
6 individuals
7 individuals
8 individuals
9 individuals
10 individuals
How many individuals are part of your group registration? (
normal pricing
AFTER May 5: $125/person)
3 individuals
4 individuals
5 individuals
6 individuals
7 individuals
8 individuals
9 individuals
10 individuals
Please share all group member names, with each name on a separate line.
Calculate total:
$0.00
Calculate
Comments/Questions
Did you attend last years conference?
Yes
No