2018 Joint Meeting of PLN, AEA & ASRED

You may transfer your conference registration to another person within your organization by August 10, 2018, by notifying Vicki Vaughn by email vsv2@msstate.edu.

If you must cancel, please notify Vicki Vaughn by email at vsv2@msstate.edu by August 10, 2018 at which time a refund for the registration amount, less a $50 cancellation fee, will be processed. Cancellations made after August 10, 2018 as well as no-shows are liable for the full registration fee.

Prefix (Mr., Mrs., etc.)

First Name *

Middle Name

Last Name *

Email Address *

Position *

First name as it would appear on the badge *

Company/Organization *

Address 1 *

Address 2

City *

State *

Zip *

Work Phone *

Extension

Fax

Food Allergies/Dietary Restrictions

First time to attend PLN Conference? *

Yes, my first time to attend PLN Conference

No, I have attended PLN Conferences before

Planning to attend the preconference on National Impact Database? *

Yes, I plan to attend - $40.00

No, I do not plan to attend

Date: Monday, August 20, 2018 1:30 PM - 4:30 PM (Eastern Time) Price: $40.00

	Early Registration	Regular Registration (July 15 – August 10)	Late Registration (after August 10)
PLN only	$370	$420	$470
PLN + AEA/ASRED	$445	$495	$545

PLN and AEA/ASRED Registration *

PLN Only - $470

PLN + AEA/ASRED - $545

Payment type *

Pay with Check

Pay with Credit Card

Person Responsible for Processing Payment

Payment Processor Email

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