2023 Conference Virtual Participant Registration

2023 Virtual Participant Registration

Please complete the form below
Full Name*

First NameLast Name
Professional Credentials
Job Title
Organization
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*
Mobile Number (will only use number in case of emergency or to share pertinent information)

Area CodePhone Number
E-mail*
example@example.com
Confirm Email*
example@example.com
This year we are offering a virtual option for those unable to attend the conference in-person. You will receive your unique link to join the conference a week prior to the event. There will be somebody monitoring the chat so that you have opportunities to ask questions about this option.

Please contact us if you have any questions: apicnm32@gmail.com
We are offering a 20% discount to APIC NM Chapter 032 members. You must enter your membership number below to qualify for the rate of $100.00
Please select from the options below:
prevnext( X )
Registration Fee (non-APIC NM members)$125.00

Discounted rate for APIC NM Chapter members$100.00

Total $0.00

Pay with PayPal

Please click one of the PayPal options to complete payment and submit the form.

2023 Virtual Participant Registration