ASAHPERD FALL CONFERENCE 2017 PRE-REGISTRATION
November 5 - 7 Hyatt Regency/Wynfrey Hotel Hoover, AL

OCTOBER 27, 2017 DEADLINE

IMPORTANT INFORMATION:

  • You must be a current member of ASAHPERD to attend the conference at the
    member rates.
  • If you miss the October 27th deadline, you may pay on-site registration fees and membership fees upon arrival at the conference.
  • It is best to pay membership online. However, you may mail in your membership payment by including the appropriate membership form available at www.asahperd.org. BRING VERIFICATION OF PAYMENT TO THE CONFERENCE.

COMPLETE THE FOLLOWING INFORMATION - ALL FIELDS REQUIRED

First Name: Last Name:
School/Work Affiliation: Home Address:
City: State
Zip: Email
Home Phone: Work Phone:

Name Badge Information
Name:
School/Work Affiliation:

Conference Registration Fee: Does not include required membership fee
Choose one:Preregistration by Oct. 27On-site Registration
Professional$75.00$95.00
Student*$25.00$45.00
Paraprofessional$50.00$70.00
Retired/Life$50.00$70.00
Non-member$120.00$140.00
*Available to full time undergraduate and graduate students. K-12 teachers in graduate school do not qualify for student rate.
Conference T-shirt
Unisex sizes run small (check one): M L XL XXL $12.00 ($15.00 for XXL)
2018 logo: “Dare Greatly” on Soft style 100% cotton; mint green (see website for picture)

 Payment Information
Total Amount Due:
Credit Card Number:
(enter without spaces)
Expiration Date (mmyy):
We accept Visa, MasterCard, American Express and Discover. All credit card payments require a $2 service charge.

***Credit card billing address must match mailing address provided above

Spam Prevention Code:   
Enter Spam Prevention Code:

REFUNDS: If you pre-register and are then unable to attend the conference, contact dhester@asahperd.org for refund details. All requests must be made PRIOR to the conference. Refund requests are subject to a 25% service charge.