2026 Mid-Fall Conference Registration

Thank you for your interest in registering for our 2026 Statewide Mid-Fall 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
Event Registration
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)
2. Event Registration
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)
3. Event Registration (Staff)
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)
4. Event Registration (Staff)
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)
5. Event Registration (Staff)
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)
6. Event Registration (Staff)
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)
7. Event Registration (Staff)
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)
8. Event Registration (Staff)
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)
9. Event Registration (Staff)
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)
10. Event Registration (Staff)
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)
11. Event Registration (Staff)
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)
12. Event Registration (Staff)
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)
13. Event Registration (Staff)
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)
14. Event Registration (Staff)
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)
15. Event Registration (Staff)
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.Format: (000) 000-0000.

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
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
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CONFERENCE DETAILS

PAYMENT DETAILS

ONLINE PAYMENT DETAILS

Paying Online