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Name
*
Institution
*
Discipline
E-mail
*
Phone
*
Date
*
Upcoming Event
Regular registration fee:
$500
Academy of Process Educators members:
$200
Hinds Community College faculty/staff:
$200
Affiliation and Preferred Payment Method
Affiliation and Fee (select one)
*
I am faculty/staff at Hinds Community College ($200)
I am a member of the Academy ($200)
I am affiliated with neither Hinds or the Academy ($500)
Current Total:
$0.00
Calculate
How would you like to pay the registration fee?
*
My school is paying for my registration
Please invoice me via PayPal (credit/debit card)
I will mail a check to Pacific Crest
Please bill me with PO #:
Please bill me with PO #:
If you choose to pay by check, send check to:
Pacific Crest
P.O. Box 370
Hampton, NH 03843-0370
Please be sure to add the event date
in the memo field of your check!
Questions/Comments
Questions/comments/reasons for attending:
Pacific Crest