Date/Time:
subject_line
Thank you for your interest in attending the Process Education Conference 2020. 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 (
earlybird pricing
BEFORE June 1)
Price $100.00
Conference Registration STUDENTS (
earlybird pricing
BEFORE June 1)
Price $50.00
Conference Registration (
normal pricing
AFTER June 1)
Price $150.00
Conference Registration STUDENTS (
normal pricing
AFTER June 1)
Price $50.00
Calculate total:
$0.00
Calculate
Comments/Questions
Did you attend last years conference?
Yes
No