Event Registration - 12/06/2018

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

Registration is not complete until payment is received.

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