2013 National Conference
(Orlando, FL)
Secure Registration Form
Credit Card Required
* Most fields required
Full name
*
First name (as preferred for badge)
*
Title
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Company/Organization
*
Address (where credit card is authorized)
*
City
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State
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Zip
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Phone
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Fax
Email
*
Number of attendees
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Pre-Conference Workshop Sign Up
Workshop (add $50)
Technical Assistance Workshop for Grantees:
Implementation to Closeout ($50)
Risk Assessment and Low-Cost
Lead Hazard Control Methods ($50)
Healthy Housing Assessment and Remediation Protocols ($50)
Child Lead Screening Strategies ($50)
Eco-Healthy Child Care Train the Trainer Program($50)
Registration Rates
The following registration rates are for registration forms received by April 24, 2013
For 1 person from the same organization: $330
For 2 persons from the same organization: $310 per person
For 3 persons from the same organization: $280 per person
For 4 or more persons from the same organization: $240 per person
Payment Amount (to be charged)
*
Credit card number
*
Card Code (CCV) - Typically on back of card
*
Exp Month (Numeric) ex. 01 = January
*
Exp Year (Numeric) example 2013
*
Name on card
*
Description of purchase
*
REGISTRATION CANCELLATION POLICY: Cancellations must be in writing. Refunds will be given to all requests received up to 72 hours before the first day of the conference, less a $45.00 cancellation fee. No refunds will be given for “no shows”.
