PARW/CC 2019 Conference Registration Form

PARW/CC 2019 Conference Registration Form

CREATING A CULTURE OF EXCELLENCE

PARW/CC Conference 2019 - A Culture of Excellence
Submit by mail to: PARW/CC, 1388 Brightwaters Blvd., N.E., St. Petersburg, FL 33704.
Or, fax your registration to (727) 894-1277.

For details about the conference, please see the 2019 Conference page.

* Indicates a required field; currency is U.S. dollar.

Member Registration: Advance: $650 between July 2, 2018 - February 1, 2019
Regular: $700 from February 2, 2019 - April 1, 2019
Non-Member Registration:

Includes a complimentary
one year membership.

Advance: $800 between July 2, 2018 - February 1, 2019
Regular: $850 from February 2, 2019 - April 1, 2019

Conference meal tickets for a guest will be available
for purchase prior to the registration reception.
Meal tickets do not include entry to the conference.

* Membership Status: I'm currently a member
I'm not currently a member
* Please make a choice above (required).
Cost:
Payment Method: Online via credit card
Via our secure, trusted processor
Offline via check or credit card
Fill in the form and print it.
Payment Method:
Credit Card #:
Expiration Date:
Security Code:
I authorize PARW/CC to charge my card for the cost above.
Signature:
If you are paying for someone else's registration, enter your info here.
Billing First Name:
Billing Last Name:
Billing E-Mail:
The fields below are for the member/registrant's information.
* Registrant's First Name:
* Registrant's Last Name:
Company Name:
* Address:
* City:
* State/Province: * Zip:
International members: Enter None in state, if applicable.
* Country:
* Phone:
Toll-Free:
Fax:
* E-Mail:
Website URL:
LinkedIn URL:
Age Group: 18-29 30-39 40-49 50-59 60-69 70 and over
Gender: Female Male
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Cancellation Policy:

Conference cancellation refunds up until September 1 will have a $100 administration fee. September 2 - December 1 the deduction is $275. December 2 - March 28 is $325. No refunds after March 29.