Clone of Conference Registration Form with Payment

2026 Atlantic Region Conference September 27-30, 2026 Conference Registration Form

Please book your spot at the upcoming conference by filling out the form below.
Full Name:

First NameLast Name
WORK INFORMATION
Church Name, Gov. Body or Agency Name:
Position:
Fill out this area with your work address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Work E-mail:
example@example.com
Work Phone Number
Format: (000) 000-0000.
MEMBER INFORMATION
Membership:
Location:

Other
If selected "Other Region" above, please identify the region name.
PERSONAL INFORMATION
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Name:
Emergency Contact's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship:
CONFERENCE INFORMATION
Arrival Date/Time:
Departure Date/Time:
APA Scholarship:
Yes, I have food allergies (they are listed):
Guest attending:

First NameLast Name
Guest relationship:
Guest Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Name for Guest:
Emergency Contact Phone Number (For Guest)
Please enter a valid phone number.Format: (000) 000-0000.
CLASS SELECTION:

Click the box to make your choices.
APA CONFERENCE AND MEMBERSHIP FEES
prevnext( X )
Conference Fee (In-person attendees only)
$195.00



Zoom Class Fee ($25.00/each)
$25.00 Quantity



Nametag Replacement
$20.00 Quantity



APA Membership Dues 2026
$25.00 Quantity



Total

$0.00
Click here to print and fill out your membership form. Mail to Joanna Bradley (see address below).
To make your hotel reservation you may click on the image

below which will then take you to a reservation page.

You may also call (302) 655-1450.
Online payments are processed through Zelle only.

To make your payment using Zelle,

scan the QR code above using your cell phone.
ALTERNATIVE PAYMENT OPTION: You may also pay by check or money order. Please make check or money order payable to Atlantic Region APA, and mail to Joanna Bradley, Atlantic Region Treasurer, Second Presbyterian Church of Baltimore, 4200 St. Paul Street, Baltimore, MD 21218. Registration and payment are due no later than AUGUST 28.
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2026 Atlantic Region Conference September 27-30, 2026 Conference Registration Form

WORK INFORMATION

MEMBER INFORMATION

PERSONAL INFORMATION

CONFERENCE INFORMATION

CLASS SELECTION:

APA CONFERENCE AND MEMBERSHIP FEES