2025 Spring Conference Registration

Thank you for your interest in registering for our 2025 Statewide Spring Conference!

Please fill out all required information below.
How many people would you like to register?*
1. Name*

First NameLast Name
1. Title*
1. Title *
1. Email*
example@example.com
Membership Type: (Select the choice that applies below)*
Member Rate (Select Registration Type)*
Non-Member Rate (Select Registration Type)*
Daily Rate (How many days are you paying for?)*
Daily Rate (Which days will you be attending)?
Event Registration*

Presidential Welcome ReceptionFamily FeudLeadership Roundtable (Ticketed Event)Awards Gala (Sneaker Ball)None of the Above
Event Registration*

Presidential Welcome ReceptionFamily FeudAwards Gala (Sneaker Ball)None of the Above
2. Name*

First NameLast Name
2. Title*
2. Title*
2. Email*
example@example.com
Membership Type: (Select the choice that applies below)*
Member Rate (Select Registration Type)*
Non-Member Rate (Select Registration Type)*
Daily Rate (How many days are you paying for?)*
Daily Rate (Which days will you be attending)?
2. Event Registration (Leadership)*

Presidential Welcome ReceptionFamily FeudLeadership Roundtable (Ticketed Event)Awards Gala (Sneaker Ball)None of the Above
2. Event Registration*

Presidential Welcome ReceptionFamily FeudAwards Gala (Sneaker Ball)None of the Above
3. Name*

First NameLast Name
3. Title*
3. Title*
3. Email*
example@example.com
Membership Type: (Select the choice that applies below)*
Member Rate (Select Registration Type)*
Non-Member Rate (Select Registration Type)*
Daily Rate (How many days are you paying for?)*
Daily Rate (Which days will you be attending)?
3. Event Registration (Leadership)*

Presidential Welcome ReceptionFamily FeudLeadership Roundtable (Ticketed Event)Awards Gala (Sneaker Ball)None of the Above
3. Event Registration (Staff)*

Presidential Welcome ReceptionFamily FeudAwards Gala (Sneaker Ball)None of the Above
4. Name*

First NameLast Name
4. Title*
4. Title*
4. Email*
example@example.com
Membership Type: (Select the choice that applies below)*
Member Rate (Select Registration Type)*
Non-Member Rate (Select Registration Type)*
Daily Rate (How many days are you paying for?)*
Daily Rate (Which days will you be attending)?
4. Event Registration (Leadership)*

Presidential Welcome ReceptionFamily FeudLeadership Roundtable (Ticketed Event)Awards Gala (Sneaker Ball)None of the Above
4. Event Registration (Staff)*

Presidential Welcome ReceptionFamily FeudAwards Gala (Sneaker Ball)None of the Above
5. Name*

First NameLast Name
5. Title*
5. Title*
5. Email*
example@example.com
Membership Type: (Select the choice that applies below)*
Member Rate (Select Registration Type)*
Non-Member Rate (Select Registration Type)*
Daily Rate (How many days are you paying for?)*
Daily Rate (Which days will you be attending)?
5. Event Registration (Leadership)*

Presidential Welcome ReceptionFamily FeudLeadership Roundtable (Ticketed Event)Awards Gala (Sneaker Ball)None of the Above
5. Event Registration (Staff)*

Presidential Welcome ReceptionFamily FeudAwards Gala (Sneaker Ball)None of the Above
6. Name*

First NameLast Name
6. Title*
6. Title*
6. Email*
example@example.com
Membership Type: (Select the choice that applies below)*
Member Rate (Select Registration Type)*
Non-Member Rate (Select Registration Type)*
Daily Rate (How many days are you paying for?)*
Daily Rate (Which days will you be attending)?
6. Event Registration (Leadership)*

Presidential Welcome ReceptionFamily FeudLeadership Roundtable (Ticketed Event)Awards Gala (Sneaker Ball)None of the Above
6. Event Registration (Staff)*

Presidential Welcome ReceptionFamily FeudAwards Gala (Sneaker Ball)None of the Above
7. Name*

First NameLast Name
7. Title*
7. Title*
7. Email*
example@example.com
Membership Type: (Select the choice that applies below)*
Member Rate (Select Registration Type)*
Non-Member Rate (Select Registration Type)*
Daily Rate (How many days are you paying for?)*
Daily Rate (Which days will you be attending)?
7. Event Registration (Leadership)*

Presidential Welcome ReceptionFamily FeudLeadership Roundtable (Ticketed Event)Awards Gala (Sneaker Ball)None of the Above
7. Event Registration (Staff)*

Presidential Welcome ReceptionFamily FeudAwards Gala (Sneaker Ball)None of the Above
8. Name*

First NameLast Name
8. Title*
8. Title*
8. Email*
example@example.com
Membership Type: (Select the choice that applies below)*
Member Rate (Select Registration Type)*
Non-Member Rate (Select Registration Type)*
Daily Rate (How many days are you paying for?)*
Daily Rate (Which days will you be attending)?
8. Event Registration (Leadership)*

Presidential Welcome ReceptionFamily FeudLeadership Roundtable (Ticketed Event)Awards Gala (Sneaker Ball)None of the Above
8. Event Registration (Staff)*

Presidential Welcome ReceptionFamily FeudAwards Gala (Sneaker Ball)None of the Above
9. Name*

First NameLast Name
9. Title*
9. Title*
9. Email*
example@example.com
Membership Type: (Select the choice that applies below)*
Member Rate (Select Registration Type)*
Non-Member Rate (Select Registration Type)*
Daily Rate (How many days are you paying for?)*
Daily Rate (Which days will you be attending)?
9. Event Registration (Leadership)*

Presidential Welcome ReceptionFamily FeudLeadership Roundtable (Ticketed Event)Awards Gala (Sneaker Ball)None of the Above
9. Event Registration (Staff)*

Presidential Welcome ReceptionFamily FeudAwards Gala (Sneaker Ball)None of the Above
10. Name*

First NameLast Name
10. Title*
10. Title*
10. Email*
example@example.com
Membership Type: (Select the choice that applies below)*
Member Rate (Select Registration Type)*
Non-Member Rate (Select Registration Type)*
Daily Rate (How many days are you paying for?)*
Daily Rate (Which days will you be attending)?
10. Event Registration (Leadership)*

Presidential Welcome ReceptionFamily FeudLeadership Roundtable (Ticketed Event)Awards Gala (Sneaker Ball)None of the Above
10. Event Registration (Staff)*

Presidential Welcome ReceptionFamily FeudAwards Gala (Sneaker Ball)None of the Above
11. Name*

First NameLast Name
11. Title*
11. Title*
11. Email*
example@example.com
Membership Type: (Select the choice that applies below)*
Member Rate (Select Registration Type)*
Non-Member Rate (Select Registration Type)*
Daily Rate (How many days are you paying for?)*
Daily Rate (Which days will you be attending)?
11. Event Registration (Leadership)*

Presidential Welcome ReceptionFamily FeudLeadership Roundtable (Ticketed Event)Awards Gala (Sneaker Ball)None of the Above
11. Event Registration (Staff)*

Presidential Welcome ReceptionFamily FeudAwards Gala (Sneaker Ball)None of the Above
12. Name*

First NameLast Name
12. Title*
12. Title*
12. Email*
example@example.com
Membership Type: (Select the choice that applies below)*
Member Rate (Select Registration Type)*
Non-Member Rate (Select Registration Type)*
Daily Rate (How many days are you paying for?)*
Daily Rate (Which days will you be attending)?
12. Event Registration (Leadership)*

Presidential Welcome ReceptionFamily FeudLeadership Roundtable (Ticketed Event)Awards Gala (Sneaker Ball)None of the Above
12. Event Registration (Staff)*

Presidential Welcome ReceptionFamily FeudAwards Gala (Sneaker Ball)None of the Above
13. Name*

First NameLast Name
13. Title*
13. Title*
13. Email*
example@example.com
Membership Type: (Select the choice that applies below)*
Member Rate (Select Registration Type)*
Non-Member Rate (Select Registration Type)*
Daily Rate (How many days are you paying for?)*
Daily Rate (Which days will you be attending)?
13. Event Registration (Leadership)*

Presidential Welcome ReceptionFamily FeudLeadership Roundtable (Ticketed Event)Awards Gala (Sneaker Ball)None of the Above
13. Event Registration (Staff)*

Presidential Welcome ReceptionFamily FeudAwards Gala (Sneaker Ball)None of the Above
14. Name*

First NameLast Name
14. Title*
14. Title*
14. Email*
example@example.com
Membership Type: (Select the choice that applies below)*
Member Rate (Select Registration Type)*
Non-Member Rate (Select Registration Type)*
Daily Rate (How many days are you paying for?)*
Daily Rate (Which days will you be attending)?
14. Event Registration (Leadership)*

Presidential Welcome ReceptionFamily FeudLeadership Roundtable (Ticketed Event)Awards Gala (Sneaker Ball)None of the Above
14. Event Registration (Staff)*

Presidential Welcome ReceptionFamily FeudAwards Gala (Sneaker Ball)None of the Above
15. Name*

First NameLast Name
15. Title*
15. Title*
15. Email*
example@example.com
Membership Type: (Select the choice that applies below)*
Member Rate (Select Registration Type)*
Non-Member Rate (Select Registration Type)*
Daily Rate (How many days are you paying for?)*
Daily Rate (Which days will you be attending)?
15. Event Registration (Leadership)*

Presidential Welcome ReceptionFamily FeudLeadership Roundtable (Ticketed Event)Awards Gala (Sneaker Ball)None of the Above
15. Event Registration (Staff)*

Presidential Welcome ReceptionFamily FeudAwards Gala (Sneaker Ball)None of the Above
Agency/Organization Information*

Agency/Organization Name

Street Address

CityState

Zip Code
Contact Email*
example@example.com
Contact 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.)*

SC Head Start AssociationSC Community Action PartnershipSC CAP Directors' AssociationNone of the above
Are you an individual member of the SCSHSA?*
Are you an individual member of the SCCAP?*
SC Endeavors ID (if applicable)

PAYMENT DETAILS
Total Amount Due ($)
Membership Type: (Select the choice that applies below)*
Member Rate (Select Registration Type)*
How many days are you paying for?*
Non-Member Rate (Select Registration Type)*
How many days are you paying for?*
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

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CONFERENCE DETAILS

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