2018 Midwest Regional Conference
Secure Registration Form
Credit Card Required
* Most fields are required
Full name
*
First name
(as preferred for badge)
*
Title
*
Company/Organization
*
Address
(where credit card is authorized)
*
City
*
State
*
Zip
*
Phone
*
Fax
Email
*
Number of attendees
*
Registration Rates
For those registering between now and August 31, 2018:
For 1 person from an organization $165
For 2 or 3 persons from an organization $150 per person
For 4 or more persons from an organization $135 per person
For those registering between September 1 and September 30, 2018:
For 1 person from an organization $175
For 2 or 3 persons from an organization $160 per person
For 4 or more persons from an organization $145 per person
For those registering after October 1, 2018:
For 1 person from an organization $190
For 2 or 3 persons from an organization $175 per person
For 4 or more persons from an organization $160 per person
Payment Amount
(to be charged)
*
Credit card number
*
Card Code (CCV) - Typically on back of card
*
Exp Month (Numeric)
example 01 = January
*
Exp Year (Numeric) example 2013
*
Name on card
*
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”.
