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Thank you for your interest in attending the Process Education Conference 2024. 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 *

Country *

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 one: *

I am a student / emeritus faculty / employed at UIndy or a partner school.

I am registering on behalf of a group of 3 or more from the same institution.

None of the above.

How will you attend the conference? *

In Person

Online

Please indicate any dietary restrictions you have:

vegetarian

vegan

gluten free

other (specify below) other (specify below)