2024 Conference Registration

2024 Changing the Climate Conference Registration

FIRST NAME

LAST NAME

ORGANIZATION

APSE MEMBER NUMBER (IF NOT A MEMBER ENTER 0000)

ADDRESS

CITY

STATE

ZIP CODE

PHONE NUMBER

ACCOMODATIONS (large print, sign language interpreter, etc., please list, if none enter N/A):

SPECIAL DIETARY NEEDS (please list, if none enter N/A):

SELECT REGISTRATION TYPE

Individual w/ a disability or family member (limited scholarships available from Governor's Council) - $125

Personal Care Assistant (COVERS MEALS ONLY) - $75

APSE Member - $200

Non-APSE Member - $225

(Early Bird Registration Ends May 31st. NO EXCEPTIONS)

By completing this form, you agree to any photography and publishing that will be taken of you.

After September 1, 2024, T-Shirt Size and Availability will be first come, first serve.

Registration deadline: September 26, 2024. After deadline date, registration must be done onsite with an increase of $100 per registration. NO EXCEPTIONS.

Refunds are available at 100% until September 1, 2024 (minus processing fees), then 50% refund (minus processing fees), is available until September 26, 2024. No refunds will be issued after September 26, 2024.

I agree to the terms & conditions above

Thanks for registering!

Please check your email for confirmation

If an email confirmation has not been sent within 48 hours, please contact arkansasapse@gmail.com.