2026 CHWSD Early-Bird MEMBER Conference Registration April 29 and 30, 2026, Mitchell, SD

2026 CHWSD Member Conference Registration Form

*Your CHWSD Membership Number (CHW/CHR or Ally) is required when completing this form to receive the discounted member rate. If you are not a member and would like to join the CHWSD to get a $50 discount on your conference registration, please visit https://chwsd.org/chwsd-memberships/ and then return to this form to complete your registration.
*If your organization needs to register 5 or more individuals for the conference and would like to receive an invoice to pay via check for the 5 or more individuals, please email info@chwsd.org.
Attendee Name*

First NameLast Name
Attendee Email*
example@example.com
Are you a member of the CHWSD?*
If you have selected "NO" this is the wrong registration form and you will not be allowed to pay and submit. Please return to the main conference registration page and choose the "Non-Member" Registration button.
CHWSD Member Number (i.e., MEM555 - CHWSD Member Numbers are 3 digits following "MEM".)*
*To locate your Membership Number, please log into your Certemy account. You can see your member number in the "Show Active Credentials" column on the left when you go into "My Credentials".
Organization*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Dietary Restrictions or Special Needs (if any)
YesNoMaybe
Promo Code (Provided only by CHWSD)

2026 CHWSD Member Conference Registration Form