2024 Conference Registration Form with Payment

Full Name*

First NameLast Name

E-mail*

example@example.com

Phone Number*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Please Check States you will be applying for CE

Please enter license #'s :

Please enter Membership Number :

How will you be Attending the conference: You must check one box.*

Live/In PersonVirtual/Zoom

File Upload Mandatory for all Virtual/Zoom Attendees*

Virtual/Zoom

Payments are processed through PayPal.

The PayLater and VENMO buttons are suspended.

You may use our link to select your payment type.

If you have any questions please email njasaifa@gmail.com.

Day I USPAP Update Education Requirement Please choose one Or not attending Day I: You must check a box!*

Hard Copy/BookPDF/Online downloadNot Attending Day I

My Products

Full Two Day Conference (NON- Member)

$595.00

Full Two Day Conference (Member: ASA-RP/ Ally)

$565.00

Day One Conference ~ Monday ONLY! (NON-Member)

$350.00

Day One Conference ~ Monday ONLY! (Member: ASA-RP/Ally)

$300.00

Day Two Conference ~ Tuesday ONLY! (NON-Member)

$350.00

Day Two Conference ~ Tuesday ONLY! (Member: ASA-RP/Ally)

$300.00

Hospitality SuiteOnly for head count purposes, Thank you!

$ Free Quantity

Staff/Instructors

$ Free Quantity

Enter coupon

Total

$0.00

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