PMA Annual Conference Registration

Publication or Main Company Name*

Person Filling out this form

First NameLast Name

Phone Number of person filling out this form

Area CodePhone Number

E-mail of person filling out this form

example@example.com

Registration fees are $595 for the 1st attendee, $495 for the 2nd attendee and $395 for 3rd+ attendees.

Enter only one name - Do not enter two names for the 1st attendee.

1st conference attendee / PLEASE ADD ONE ATTENDEE ONLY**

Enter only one name - Do not enter two names for the 2nd attendee.

2nd Conference attendee / PLEASE ADD ONE ATTENDEE ONLY**

3rd and additional Conference attendees / multiple names allowed

Workshop attendees

Calculated attendee fees total

Do not edit. If you enter an attendee you cannot just erase their info to recalculate. If the fee is not adding up correctly, RESET the form with the green button below and enter your information again.

Would you like to pay by Credit Card?

Yes, I can pay by Credit Card nowNo, please invoice me

Fees

USDDescription

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Additional Notes or Comments: