PSHFE 2023 Spring Conference Educational Attendee Registration Form

April 13th & 14th, 2023

Red Lion Hotel Harrisburg Hershey

4751 Lindle Road

Harrisburg, PA 17111

Question Title

* 1. First Name

Question Title

* 2. Last Name

Question Title

* 3. Title

Question Title

* 4. Organization Name

Question Title

* 5. Street Address

Question Title

* 6. City

Question Title

* 7. State

Question Title

* 8. Zip Code

Question Title

* 9. Email Address

Question Title

* 10. Phone Number

Question Title

* 11. I am registering for:

April 13th session only - Member fee $50

April 13th session only - Non-member fee $75

April 14th session only - Member fee $125

April 14th session only - Non-member fee $175

BOTH April 13th & 14th sessions - Member fee $175

BOTH April 13th & 14th sessions - Non-member fee $250

Question Title

* 12. Similar to past conferences, we will have representatives from the PA Department of Health (both DSI and DAAC) presenting on Friday afternoon. If you have any specific topics you would like to hear about, or any questions you would like answered, please submit them so we can let them know to address them in their presentations.

Question Title

* 13. Please list any special accessibility or dietary needs.

Question Title

* 14. Will you need a certificate of completion for ASHE CEU credits?

Yes

No

Question Title

* 15. Will you be attending the Thursday evening reception?

Yes

No

Question Title

* 16. Will you be attending the Friday morning continental breakfast?

Yes

No

Question Title

* 17. Are you a current ASHE member?

Yes

No