Conference Registration

Your name (first, middle, last) *

Street address *

Street address (continued)

City *

State or province *
S E L E C T Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Lousiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Yukon Territory -or-

Zip code *

Daytime phone *

Evening phone

Email address *

How did you hear about this conference?

This conference is free to all CAPPA members, although for registration a valid credit card is necessary to reserve your seat. Your card will not be charged, provided you are a member of CAPPA. In the event you cannot attend the conference for any reason, 30 days cancellation notice is required, or a processing fee of $75 will be charged to your credit card. All cancellations must be mailed to CAPPA, postmarked no later than 30 days before the conference. No exceptions for any reason can be made. We do not accept e-mailed or faxed cancellations. For those who do not register by July 23rd, 2008, there will be a $50 late conference registration fee that will be chanrged to your credit card.

Enter 'yes' here *

Enter your name here *

If you are not yet a member, but would like to attend the conference for free, you may join CAPPA now by choosing 'yes' H E R Enoyes and selecting a membership term H E R EOne year - $45Two years - $80. Your credit card will be charged for your membership fee.

Please consider making a donation to the CAPPA Foundation to support this conference. Your donation is 100% tax deductible. The names of members who make a donation will be listed in the CAPPA conference manual. The donation will be charged to your credit card.

Would you like to make a donation? *
S E L E C T $0.00 $10.00 $20.00 $30.00 $40.00 $50.00 $100.00

Would you like to volunteer at the conference?
If yes, a CAPPA representative will be in contact with you.
yes   no

Would you like to donate an item to the silent auction?
If yes, a CAPPA representative will be in contact with you.
yes   no

Credit card type *
S E L E C T American Express MasterCard Visa

Credit card # *

Expiration date *

Cardholder's name *

Comments, notes, etc.