2012 EAST WEST WITH CC

Lead & Healthy Housing Conferences

Secure Registration Form

(Credit Card Required)

Lead & Healthy Housing EAST
December 12 – 14, 2012
Philadelphia

Lead & Healthy Housing WEST
January 30 – February 1, 2013
Los Angeles

* = Required Field
Select Which Conference Attending
Select One	*	EAST WEST

Full name	*
First name (as preferred for badge)	*
Title
Company/Organization	*
Address	*
City	*
State	*
Zip	*
Phone	*
Fax	*
Email	*
Number of attendees	*

Conference Rates
For 1 person: $225 For 2-4 persons from the same organization: $200 per person For 5 persons or more from the same organization: $175 per person

Credit Card Information (secure)
Card Holder's First Name	*
Card Holder's Last Name	*
Card Number	*
Expiration Date ( Month ) Ex. 09	*
Expiration Date ( Year ) Ex. 2011	*
Card Code (CCV)	*
Amount being charged (do not add $ sign)	*
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”.

Lead & Healthy Housing Conferences

Secure Registration Form

Select Which Conference Attending

Conference Rates

Credit Card Information (secure)