The deadline for pre-registration was April 8th.

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ASAHPERD SPRING CONFERENCE 2016 PRE-REGISTRATION

April 15-16, 2016 Phoenix VI & VII Orange Beach, AL

* Please note: All form fields below are required.
Please ensure your zip code matches the billing zip code on your credit card.

First Name:* Last Name:*
Home Address:* City:*
State:* Zip:*
Email:* Home Phone:*
Confirm Your Email:* Work Phone:

Name Badge Information (First, Last, Work Affiliation)
Name:*
School/Work Affiliation:*

Conference Registration Fees (Does not include membership fee)

Important Information:

  • If you teach, coach, or are employed (or student) in the area of health, physical education, athletics, fitness, etc. you must be a current member of ASAHPERD to attend the conference. Join online at www.asahperd.org or pay at the conference.
  • If you miss the April 8 postmark deadline, you may pay registration and membership fees upon arrival at the conference.
  • See details for Purchase Orders below. NOTE: Paying with a PO requires additional time. The school check must be received by April 8.

Membership:

  • It is best to pay membership online. However, you may include membership payment with your preregistration by including the appropriate membership form available at www.asahperd.org. If you pay your membership dues online AFTER APRIL 12, you must bring verification of payment.

Refunds:

  • If you pre-register and are then unable to attend the conference, submit notification in writing and return your receipt along with a self-addressed stamped envelope postmarked by April 14, 2016 to the address below. Refund requests are subject to a 25% service charge. No refunds are available after this deadline.
Choose one:*
Professional$55.00
Student$20.00
Aide$30.00
Retired/Life$20.00
Non-member$105.00
Family*$55.00
Name on family/guest badge:
*Family member over the age of 18 accompanied by a paying ASAHPERD member registered on this form.

 Payment Information (Billing address must match address provided above)
Total Amount Due:*
Credit Card Number:*
(enter without spaces)
Expiration Date (mmyy):*
We accept Visa, MasterCard, and Discover. All credit card payments require a $2 service charge.

Upon sending the pre-registration application you will get a receipt via email. Save this receipt and bring it with you to pick up your registration materials.

Spam Prevention Code:   
Enter Spam Prevention Code:

Please submit this form only ONCE.

Refunds: If you pre-register and are then unable to attend the conference, submit notification in writing and return your receipt along with a self-addressed stamped envelope postmarked by April 16, 2016 to the address below. Refund requests are subject to a 25% service charge. No refunds are available after this deadline.