* First Name

* Last Name

Organization

Title

* Address 1

E.g.: 1234 La Messa Drive

Address 2

E.g.: Apt 4

* City

* State AlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutDistrict of ColumbiaDelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyoming

* Zip

* Work Phone

* Home or Cell Phone

For weather emergencies/event cancellation purposes only.

* Email

This is my first PREP/APRA conference

I am a paid member of PREP/APRA registering for the conference - $65 (Click here to see if your 2008 dues are paid.)

I am a paid member of PREP/APRA registering for both the conference ($65) and the social ($15) - $80 (Click here to see if your 2008 dues are paid.)

I am becoming a member of PREP/APRA ($25), and registering for the conference ($65) - $90 (Click here to complete the online membership application.)

I am becoming a member of PREP/APRA ($25), and registering for both the conference ($65) and the social ($15) - $105 (Click here to complete the online membership application.)

I am a nonmember registering for the conference - $115

I am a nonmember registering for the conference and social - $140

NOTES

• A continental breakfast, lunch, and snacks are included in the conference fee. A vegetarian lunch option will be available.
• Dress is Business Casual
• PREP/APRA has no control over the temperature of the conference room.
• PREP/APRA intends to provide professional contact information (work address and phone number) for conference attendees to our presenters.
• Refunds are available for cancellations received on or prior to October 15; no refunds are available after October 15