Please complete the form below and click the Submit button when you are finished. You will then be asked to review and confirm your selections.
Registrant Information |
| * Name: |
Check if you are a new member |
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| * Street Address: |
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| Address 2: |
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| * City: |
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| * State: |
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| * Zip Code: |
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| * Phone Number: |
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| Fax Number: |
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| * Email Address: |
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Fees |
You do not need to enter anything into the grey boxes on the right. They will self-populate as you make your choices.
A. Registration Fees: |
| * Member Fee Type: |
Early registration ended May 21. Fees are an additional $60 (except students, additional $30).
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$
.00 |
| Partner Tickets ($140) [See pg. 32]
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Check if purchasing
Partner Name:
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$
.00 |
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| B. CEU Credit ($35) [See pg. 5] |
Check if paying for CEU credit
CEU Credit Type:
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$
.00 |
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| C. Special Event: Thursday, June 19 ($65) [includes dinner, see pg. 19] |
Select number of tickets
$65 x
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$
.00 |
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| D. Tour of the Murals of Philadelphia: Friday, June 20 ($20) [See pg. 22] |
Select number of tickets
$20 x
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$
.00 |
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E. Institutes: Friday, June 20
($50) [includes light dinner, see pg. 25]
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Women's
Men's
No Thanks
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$
.00 |
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| F. Extra Guest Tickets for Awards/Party: Saturday, June 21 ($65) * |
Select number of tickets. $65 x
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$
.00 |
| * EACH FULL REGISTRATION INCLUDES ONE PARTY TICKET.
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Total Amount To Be Charged: |
$
.00 |
Meeting Session Choices |
| * Program Partners (See pg. 13):
Yes I will participate
No thanks |
Wednesday, June 18:
[See pg. 13]
People of Color Network
OR
Conversation on White Privilege and Accountability OR
LGBTQ Network
None
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Thursday, June 19:
*
New Member and Student Breakfast:
Yes
No
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I will be attending (Human Rights Forum I or Brief Presentation):
The Human Rights Forum
OR
Brief Presentations (See pp. 15-16): Group#
Group 1,
Group 2,
Group 3,
Group 4
*
I will be attending (Human Rights Forum II or Interest Groups):
The Human Rights Forum II
OR
Interest Groups (See pp. 17-18): Group #
Group 1,
Group 2,
Group 3,
Group 4,
Group 5,
Group 6
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Friday, June 20:
*
I will be attending (Cultural and Economic Diversity Forum or Interest Groups):
Cultural and Economic Diversity Forum
OR
Interest Groups (See pp. 17-18): Group #
Group 7,
Group 8,
Group 9,
Group 10,
Group 11
*
I will be attending (Family Policy Forum or Brief Presentation):
Family Policy Forum
OR
Brief Presentations (See pp. 22-24): Group#
Group 5,
Group 6,
Group 7,
Group 8,
Group 9
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Saturday, June 21:
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Brief Presentations (See pp. 26-27): Group #
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Interest Groups (See pp. 27-29): Group#
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Personal Needs
* Special Diet/Vegetarian/Vegan:
* I need assistance at the Meeting due to a physical disability.
My needs are:
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