2025 ESAP CONFERENCE Registration Form

2025 ESAP CONFERENCE

REGISTRATION FORM
Registrant Details:
Full Name*

First NameLast Name
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Place of Employment: *
Title/ Position: *
Phone Number*
E-mail*
example@example.com
Shirt Size (PLEASE note that shirts are NOT guaranteed for late registrants):
Will this be your first ESAP Conference?:*

YesNo
Do you have dietary restrictions:

YesNo
DUES & REGISTRATION FEES:

Please check applicable boxes. Please note that you must check membership box in order to register for conference. If you are ONLY paying for membership this year and WILL NOT be attending the conference, please check the "MEMBERSHIP ONLY" box under Conference Registration.
MEMBERSHIP DUES (REQUIRED/ PLEASE CHECK BOX)*

2025 MEMBERSHIP DUES $ 50
CONFERENCE REGISTRATION*

CONFERENCE REGISTRATION (Early, Postmarked by 8/3/2025) $200CONFERENCE REGISTRATION (LATE, Postmarked AFTER 8/3/2025) $225MEMBERSHIP ONLY. I WILL NOT be attending the 2025 Conference.
GUEST EVENT TICKET

GUEST TICKET (includes social event ONLY) $ 30No Guest Ticket Needed
TOTAL DUE
METHOD OF PAYMENT:

Please check the applicable payment method:
Check enclosed: All payments should be mailed to ESAP PO Box 623 CANTON, MS 39046
Check#
Invoice my Department
PO#
I will be bringing my payment to the conference. NOTE: all payments received after 8/3/2025 are considered LATE registration.
IMPORTANT NOTE: Please include a copy of the registration form or attendee's name on check when sending against a purchase order.
HOTEL RESERVATION INFORMATION
Hotel & Venue:

The Golden Nugget

151 Beach Blvd.

Biloxi, MS 39530

Room Rates:

$69.00 to $89.00 nightly

(plus tax & fees)

Reservation Info:

Use GROUP CODE: S250363

Call 800-777-7568

or

Direct Link:

https://goldennuggetbiloxi.reztrip.com/ext/promoRate?property=1262&mode=b&pm=true&sr=1002929&vr=3

Please note that cut-off date: Thursday, August 3, 2025 or until block is full.
Should be Empty:

2025 ESAP CONFERENCE

DUES & REGISTRATION FEES:

METHOD OF PAYMENT:

HOTEL RESERVATION INFORMATION