NDRPA Conference Registration 2018

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* Participant contact information:

Name

Agency

Phone

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* List certifications (e.g., CPSI, CPRP, AFO, etc.):

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* Dietary restrictions or special accommodations:

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* Tuesday activities (select one):

Golf at noon

Winery tour from 2:30-4:30 p.m.

Neither

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* I plan to participate in the following meals:

Tuesday lunch

Tuesday social and dinner

Wednesday breakfast

Wednesday lunch

Wednesday awards banquet

Thursday breakfast

Thursday lunch

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* Registration type (select one):

Member Full Package = $125

Nonmember Full Package = $150

Member Wednesday Only = $70

Nonmember Wednesday Only = $90

Student = $20

Retired Member = $65

Banquet Ticket ONLY = $25

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* Payment options (select one):

Please note: PayPal is unable to accept multiple payments for registration with the same credit card. As an alternative option for payment of multiple registrations, please choose the invoice option and submit a check.

I need an invoice to pay by check

I want to pay by credit card with PayPal

Question Title

* Participant contact information:

Question Title

* List certifications (e.g., CPSI, CPRP, AFO, etc.):

Question Title

* Dietary restrictions or special accommodations:

Question Title

* Tuesday activities (select one):

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* I plan to participate in the following meals:

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* Registration type (select one):

Question Title

* Payment options (select one):Please note: PayPal is unable to accept multiple payments for registration with the same credit card. As an alternative option for payment of multiple registrations, please choose the invoice option and submit a check.

* Payment options (select one):

Please note: PayPal is unable to accept multiple payments for registration with the same credit card. As an alternative option for payment of multiple registrations, please choose the invoice option and submit a check.