2013 ACE-DHH Conference Registration

2015 ACE-DHH Conference Registration

St. Louis, Missouri February 12-14, 2015
Payment Options include:

Paying online via a secure server. US Attendees: Square Market (available now) International Attendees: PayPal (coming soon).You will be prompted at the completion of this form to visit the secure site. OR Paying by paper. You may send a check or money order to: ACE-DHH c/o Dr. Sara Schley, 52 Lomb Memorial Drive Building 60 Office 2754 Rochester, NY 14623 Fax: 585-475-2525
Full Name

PrefixFirst NameLast NameSuffix
Name for Badge
Affiliation
Title
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail
Office Phone Number

Area CodePhone Number
Cell Phone Number

Area CodePhone Number
Woud you like to receive text alerts while at the conference?
Fax Number

Area CodePhone Number
Hearing Status
Sign language interpreters will be available at all meeting times and the Saturday evening banquet. If you have comments regarding interpreting during the conference please provide them in the box below.
Please indicate whether you will be staying for the banquet Saturday evening.
Will you need a vegetarian option: yes no
Conference Registration
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Early Bird Registration Member (by Dec 31)$300.00

Early Bird Registration Non-Member (by Dec 31)$350.00

Early Bird Registration Student (by Dec 31)$225.00

Pre-Registration Member (Jan 1 - Feb 1)$350.00

Pre-Registration Non-Member (Jan 1 - Feb 1)$400.00

Pre-Registration Student (Jan 1 - Feb 1)$250.00

Late/Onsite Registration Member (after Feb 1)$400.00

Late/Onsite Registration Non-Member (after Feb 1)$450.00

Late/Onsite Registration Student (after Feb 1)$275.00

Total $0.00
Name of the person registering/paying for your registration
Time & Date

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Just for your records . . .

Please print a copy of this form for your records. By clicking "Submit", this form will be sent electronically to ACE-DHH.
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2015 ACE-DHH Conference Registration

Payment Options include:

Conference Registration

Just for your records . . .