82nd IPHA Annual Conference Registration
Starved Rock Lodge - September 6-7, 2023
Contact Information
Name
*
First Name
Last Name
Organization
*
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Email
*
example@example.com
Phone Number
*
Back
Next
Accessibility Accommodations
Dietary Restrictions
*
None
Dairy Free
Gluten Free
Vegetarian
Vegan
Other
If you answered other above, please specify.
Requested Accommodations
*
None
Large Print Materials
Auditory Assistance
Mobility Assistance
Mother's Room
Sensory Friendly Room
Spanish Translation
Other
If you answered other above, please specify.
Back
Next
Information Sharing
I consent to my registration information being shared with Conference Sponsors.
*
Yes
No
Back
Next
Registration Fees
Annual Conference Registration Fees
*
prev
next
( X )
IPHA Member - Annual Conference Registration
IPHA Member - Annual Conference Registration
$
200.00
Non-IPHA Member - Annual Conference Registration
Non-IPHA Member - Annual Conference Registration
$
275.00
Student - Annual Conference Registration
Student - Annual Conference Registration
$
100.00
Submit
Should be Empty: