Basic Information

Please provide the requested information on the following three pages to register as a conference attendee or exhibitor. Please be advised you cannot save your information and return to it at a later time. For any questions, please contact Resham Shirsat at (preferred) or 813-757-2136. Upon receipt of your registration and payment, you will recieve an email using the address you provided to confirm your registration has been processed.

* 1. First and Last Name

* 2. Name of Institution/Organization (as you would like it seen on your name tag)

* 3. Phone Number with Area Code

* 4. Email (this is where your email confirmation will be sent after payment has been received)