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Conference Registration Form

No registration refunds will be issued after August 31st.
Download the registration form instead.
Please enter your contact information.
Title:
*First Name:
Middle Inital:
*Last Name:
Your Job Position:
Institutional Affiliation or Employer:
*Address Line 1:
Address Line 2:
Address Line 3:
City:
State or Province:
Zip or Postal Code:
Country:
*Telephone:
Fax:
*Enter your preferred email:
*Re-enter Email:
Website, enter URL after http://


Registration Rates

Pre-August 1 (priority registration)

  • PJSA Individual Member, $145
  • Non-member Individual, $185
  • PJSA Institutional Member, $395
  • Non-member Institution, $475
  • PJSA Low-income Member, $60
  • Non-member Low-income, $85
  • Student (PJSA member), $40
  • Student (non-member), $50

Post-August 1 (regular registration)

  • PJSA Individual Member, $175
  • Non-member Individual, $215
  • PJSA Institutional Member, $445
  • Non-member Institution, $525
  • PJSA Low-income Member, $75
  • Non-member Low-income, $100
  • Student (PJSA member), $50
  • Student (non-member), $60

Up to 10 individuals may attend on an institutional registration.

*Select your conference registration level:
(see fee structure above for explanation)
Number of Registrants:
(Inst level should indicate total #)


Pre-Conference Workshops on Thursday, Oct. 17
I intend to participate in:


Number of Banquet Tickets ($45 each)
(includes Awards Ceremony, non-refundable)
Indicate Banquet Meal Preference:
(we will try to honor it.)
If you are purchasing registrations or banquet tickets for someone other than yourself (especially for institutional registrations), please specify their name(s) in this box. You can also indicate banquet meal preferences here.


Today's Date:
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