Attendee Information
Please fill name and contact information of attendee(s)
Name of Attendee
*
First Name
Last Name
Organization (if applicable):
Email Address
*
example@example.com
Contact Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please list names of additional attendees, if applicable, as they should appear on the name tags (separate names with commas):
*
Registration Rates (Each registration includes a light breakfast and lunch. Snacks and beverages will be available throughout the day (at no additional charge):
*
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Standard Rate
$
35.00
Quantity
1
2
3
4
5
6
7
8
9
10
Student Rate
[K-12, Undergraduate Students]
$
20.00
Quantity
1
2
3
4
5
6
7
8
9
10
Presenter Rate
[For those on the symposium agenda as presenters/panelists]
$
20.00
Quantity
1
2
3
4
5
6
7
8
9
10
Payment Methods
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Please click one of the PayPal options to complete payment and
submit
the form.
SUBMIT REGISTRATION!
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