Event Registration - 04/11/2019

Please register separate for each attendee. Registration must be under the attendee's name (not the person completing the registration).

REGISTRATION IS CLOSED

First Name of Attendee *

Last Name of Attendee *

Email Address *

Confirm Email Address *

Title *

Company Name *

Address

City

State

Zip

Phone *

How did you hear about this conference?

Are you registering for a guest? *

Yes

If so, what is the guest's name?

This should be completed if you completed this form with YOUR NAME. The actual attendee's name should be provided here.

Registration Type *

Member Rate

Non-Member Rate

Student or Unemployed Rate

Payment *

I understand that the payment process is required in order to register for this event. Payment will be processed on the following screen.

Payment Type *

Pay Online

Mail Check

CAPTCHA

This question is for testing whether you are a human visitor and to prevent automated spam submissions.

Northeast Pennsylvania Chapter of SHRM