2024 Conference Registration

Counselor Registration
Full Name*

First NameLast Name
Job Title*
School*
Conference Participant's Email*

Confirmation EmailThis field MUST be the registrant / participant's email. You can enter a billing email later.
Conference Participant's Phone Number*
Work Setting*
Work Type*
Work County*

Do you agree to allow select conference sponsors to email you?*

YesNo
Do you have a special meal request?*

NoYes - VegetarianYes - VeganYes - Dairy-FreeYes - Gluten-Free
Do you plan to attend our Welcome Reception on February 5?*

YesNo

Registration Type*

Members and Non-Members

$475.00

PresentersMUST be on approved list to qualify.

$250.00

Administrators

$375.00

Students

$185.00

Retirees

$185.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Email for Receipt*

Confirmation Emailexample@example.com
Conference Code of Conduct

By registering for this event, you agree to follow our Conference Code of Conduct.
I have read the AzSCA Conference Code of Conduct and agree to follow it.
Click the Submit button once and wait for the confirmation screen.
Should be Empty: