2023 Mid-Fall Statewide Conference Registration

Thank you for your interest in registering for our 2023 Statewide Mid-Fall Conference!

Please fill out all required information below.
Name*

First NameLast Name
Title*
Agency/Organization Information*

Agency/Organization Name

Street Address

CityState

Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.

CONFERENCE DETAILS
Which affiliate association is your organization a member of?*
Please Note: Agency & Participants must be members to qualify for the member rate. Agencies will be billed the non-member rate if non-members are registered at the member rate.
Are you an individual member of the SCSHSA?*
Are you an individual member of the SCCAP?*
SC Endeavors ID (if applicable)

PAYMENT DETAILS
Membership Type: (Select the choice that applies below)*
Member Rate (Select Registration Type)*
Non-Member Rate (Select Registration Type)*
Select Payment Method*
Check #*
Purchase Order #*
***Your online payment will be handled via PayPal on the next page. Please note that PayPal charges a small fee for online processing.

ONLINE PAYMENT DETAILS
Paying online*
prevnext( X )
Regular Registration (Member)PayPal fees will be charged for this transaction
$570.40



Regular Registration (Non-Member)PayPal fees will be charged for this transaction
$622.20



Late Registration (Non-Member)PayPal fees will be charged for this transaction
$699.92



Daily Rate (Member)PayPal fees will be charged for this transaction
$206.43



Daily Rate (Non-Member)PayPal fees will be charged for this transaction
$259.21



Total

$0.00

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