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
Choose from one of the PayPal options to
make your payment.
SUBMIT REGISTRATION!
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