NCAPSE Conference Registration Name of Conference Attendee* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Job TitleOrganization*Phone*Email Address of Attendee* What Accommodations Will You Need?Please include accessibility and anything else we can do to make the conference easier for you, including accommodations and dietary needs.Are you a member of APSE/ NC APSE?**YesNoMember Number*NC APSE Member Price*Early Bird Registration (by 3/09/20): $235.00Regular Registration (after 3/09/20): $265.00Non- NC APSE Member Price*Early Bird Registration (by 3/09/20): $265.00Regular Registration (after 3/09/20): $290.00How will you be paying?*Credit CardCheckPre-approval Code*All check payments now require pre-approval. If you have not yet done so, email us at ncapse@ncapse.org for pre-approval and to receive a code.Credit Card Fee* Price: $0.00 A fee of 3% will be added to all credit card transactions.Check Payment InstructionsYour registration will be complete upon receipt of your check payment. Please click Complete Your Registration Now below. You will also be emailed these instructions. Note your name and organization in the memo field of your check. Please make all checks payable to and send to: NCAPSE Michael Maybee PO Box 2330 Boone NC 28607Questions?Have questions about registration? Please contact ncapse@ncapse.org or call 919-413-7476. Note: If you are unable to attend the conference for any reason, you may substitute another conference attendee in your place. Refunds are not available on conference registration. Make sure to complete your registration by clicking the button below.Total $0.00 Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Expiration Date Security Code Cardholder Name NameThis field is for validation purposes and should be left unchanged. We would welcome the opportunity to serve you as a member of NCAPSE. For additional information please contact us
