| Full Name |
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| Address |
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| Phone Number | Work: _______________________ Home: _________________________ | ||||||||
| Email Address | _______________________________________ | ||||||||
| Registration | General Registration: ___ $105 Full Conference - Member ___ $130 Full Conference - Non-Member (includes one year of membership) ___ $55 Student Full Conference (includes one year of membership) ___ $55 Low Income Full Conference - Member ___ $65 Low Income Full Conference Non - Member (includes a one year membership) Single-Day Registration: ___ $60 Member Sunday only ___ $50 Member Monday only ___ $70 Non-Member Sunday only ___ $60 Non-Member Monday only ___ $30 Student/Low-Income Day Rate Sunday Evening Dinner: ___ $25 Open to those who have registered for the full conference or Sunday only Dinner and discussion with workshop presenters and fellow attendees. Vegetarian options will be available. Evening Plenaries: $10 (suggested donation) Payable at the door only |
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| Registration fees include all public sessions only. | |||||||||
| Credit Card | VISA ___ MASTER CARD ___ | ||||||||
| Name on Credit Card | __________________________________ | ||||||||
| Card Number | ___________________________________ | ||||||||
| Expiration | Month: __________ Year: _____________ |
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| Payment | I wish to make an additional contribution of $ ___________ to help subsidize student and low-income registrations. Total amount to be charged to your credit card: $ ____________________ (Registration Fees are non-refundable) |