1.Name

2.Organization

3.If registered as part of a group, please list other registrants from your organization:

4.I/my organization would like to:

Make a tax-deductible contribution of all or part of my/our registration fees to help offset unrecoverable conference costs. Please note amount below.

Request a full refund of registration fees paid.

Keep the registration fees paid "on account" to use toward a future purchase (2021 Conference, Fall Mini-Conference, webinars, membership dues, etc.)

5.Notes/Special Instructions: