2025 Mid-Fall Conference Registration

Thank you for your interest in registering for our 2025 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*

Presidential Welcome ReceptionLeadership Roundtable (Ticketed Event)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
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CONFERENCE DETAILS

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