AFP Professional Development Program Registration

Full Name*

First NameLast Name
AFP Member?*

YesNo
Student?

YesNo
Phone Number*

Area CodePhone Number
Company:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
example@example.com
Date of AFP Program*
Additional names and email addresses of those attending:
Do you have a dietary request for the meals?
Do you want to be invoiced?

YesNo
Credit Card Payments

To pay by credit card please use link: Credit Card Link
Payments via check:

Please make checks payable to:
AFP Mahoning-Shenango Chapter

Mail check to:
AFP Mahoning-Shenango Chapter
PO Box 672
Youngstown, OH 44501
Should be Empty: