2010 Conference Registration Form

The Conference is $50 general admission and $30 for student & members of AAPDEP. The Banquet (optional) is $50.

Only fill out this form if you are prepared to pay the registration fee (see above)) with a credit/debit card. Registration covers material and cost of food for both days. If you want to mail in a check, then please print this page, fill it out, and mail it in with the check. After you submit this form you will be forwarded to Paypal for payment. Thank you.

Name Organization (if applicable) Primary Phone Cell Phone (if different) Fax Number (if available) Email Address City State (if applicable) Postal Code Country Skill or interest for participation in AAPDEP Dietary Restrictions Housing I would like to stay (free of charge) with a friend of AAPDEP in the St. Petersburg community. (This will be based on availability). Attendance at Conference and/or Banquet I will attend only the Banquet ($50).
I will attend both the Conference and the Banquet ($75).
I will attend only the Conference; I am a student ($30).
I will attend only the Conference; I am an AAPDEP Member ($30).
I will attend only the Conference; I am not a student or an AAPDEP Member ($50).

Conference Information

2010 Conference Registration Form