Online Registration (Credit/Debit Cards ONLY)

* 1. What is your first name?

* 2. What is your last name?

* 3. What is your street address, including city, state and zip?

* 4. What is a phone number where you can be reached?

* 5. Enter an email address below where invoice should be sent.

  • Basic Registration $25
  • Full Registration $60
  • Banquet Ticket $35
  • Saturday Dance $5
  • Comedy Show Ticket (prepaid) $10

* 6. In the response field below, please enter how many and what you would like to register for:
(e.g. 1 Basic Registration, 1 Full Registration)

(Note: You will receive an invoice from Square to pay your registration fees. Once the invoice is sent you have 24 hours to pay the invoice or your registration will be CANCELLED and you will need to register again.)

* 7. If you purchased a banquet ticket, do you prefer chicken & fish or vegetarian?

* 8. Do you have any special needs that require special accomodation?

 
Thank you for registering for COACNA XXVII, January 5-7, 2018, Columbus Ohio

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