2013 National Conference Registration

Attendee Information - Basic:

First Name:*

Last Name:*

Organization

Title

Department

Primary Email:*

Telephone Number:*

Fax Number:

Any Special Needs?:

Your Nametag Text:

* = Required Field

Attendee Information - Nametag:

Please Check All That Apply

USDLA Member

USDLA State Chapter Member

IFWE Alumni

USDLA Social Network Member

USDLA Award Winner

Conference Presenter

Please unclick this checkbox if you would NOT like your name to appear on the distributed conference attendee list.

Attendee Information - Address:

Country:*

Address Line 1:*

Address Line 2:

City:*

State:*

Zipcode:*

* = Required Field

Registration Information:

Registration Type:*

Payment Method:*

Renew/Join USDLA Today at a Special Conference Discounted Rate! ($100)

* = Required Field

Pre-Conference Workshops:

Yes! I would like to register for the following Pre-Conference Workshop on
April 28, 2013 from 2-5pm (please choose one only):

State Chapter Leadership Workshop

FREE

I Have the State Application. Now What Do I Do?

FREE

Pushing Interaction to Intersubjectivity: Tools for Powerful Online Discussions

FREE

Essential Links in Grant Proposals: Problem Statements and Performance Measures

FREE

USDLA Sunrise Registration:

Yes! I would like to register for the Bill Jackson Memorial Sunrise Walk/Run to take place each morning at 6:00AM during the Conference.

By clicking here you acknowledge that you have read and accept our Release from Liability

Billing Information:

Information Same as above?*

First Name:*

Last Name:*

Billing Email:*

Billing Telephone:*

Billing Fax:

* = Required Field

Billing Address:

Country:*

Address Line 1:*

Address Line 2:

City:*

State:*

Zipcode:*

* = Required Field

Cancellation & Refund Policy
Cancellations must be received prior to April 1, 2013 in order to receive a conference refund.
All refunds will be processed after May 1, 2013. (less a $75.00 processing fee per registration).

Cancellations after April 1, 2013 will not be refunded. However, a substitute may attend for the registered attendee.