2019 Annual Conference Registration Form Download the Registration Form – or – Annual Meeting - 2019 Sign up for our 2019 Annual Meeting here! Step 1 of 3 33% Number of people in partyI would like to register myself onlyI would like to register myself and an additional personName* First Last Preferred Badge Name*Email* PhonePlease add me to your mailing listYesNoSpouse / Guest / Co-Worker informationSpouse / Guest / Co-Worker Name First Last Spouse/Guest/Co-Worker Preferred Badge NameSpouse / Guest / Co-Worker Email PhonePlease add my spouse/guest/co-worker to your mailing listYesNo 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 Comments Please choose when you will attendEnter the quantity of tickets you would like for either the entire Annual Conference and Dinner or choose days a-la-carte. The fees are as follows: $210 - Full Conference (Includes Saturday Dinner) $75.00 - Thursday Only $85.00 - Friday Only $50.00 - Saturday Only $50.00 - Saturday Dinner RegistrationI will attend the entire conference or only one or two days.I would like to attend the entire conferenceI would like to attend one or two days only and pay for just those days.Choose Your AttendancePlease pay for one registration per person in your partyPlease Choose Your AttendanceEntire Conference, Includes Dinner- $210.00Thurs. Sept. 26 - 1 Day Registration- $75.00Fri. Sept. 27th - 1 Day Registration- $85.00Saturday Sept. 28th - 1 Day Registration OnlySaturday Sept. 28th - Annual Conference DinnerSaturday Dinner Choice (If attending)Roast Prime Rib of Beef – with a Garlic-Thyme JusSeafood Brochette- Shrimp, Scallop, SwordfishRochester Yacht Club Chicken - Stuffed w/ Crab, artichoke hearts & asiago cheese, wrapped in phyllo doughSecond Guest Saturday Dinner Choice (If attending)Roast Prime Rib of Beef – with a Garlic-Thyme JusSeafood Brochette- Shrimp, Scallop, SwordfishRochester Yacht Club Chicken - Stuffed w/ Crab, artichoke hearts & asiago cheese, wrapped in phyllo doughTotal $0.00 Choose Your Payment Method*PaypalCredit CardCredit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name EmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.