Annual Conference Registration Form

ANNUAL CONFERENCE REGISTRATION FORM

Conference Title:    Location:

Conference Dates:

Attendee Information

Parent / Guardian (If Registrant is a Minor)

Registrant is under 18 years of age:

Registration Options & Fees

Registration Type (select one):
Regular attendee    Student rate    Faculty    Presenter

Additional Options:
Printed materials packet    Gala dinner ticket

Session / Workshop Selection

Please indicate sessions you plan to attend (check all that apply). Selection is subject to space and capacity limits.

Workshop A: Innovative Teaching Practices
Workshop B: Assessment & Feedback
Panel: Equity in Education
Roundtable: Curriculum Design

Accessibility, Medical & Dietary

Emergency Contact

Payment Authorization

Payment Method:
Credit Card    Check    Invoice

By providing payment information and signing below, the registrant authorizes the conference organizer to charge the amount due for registration and selected options. The registrant acknowledges responsibility for all fees incurred.

Policies, Waiver & Consent

Cancellation & Refunds: Registrations cancelled in writing at least 30 days prior to the first day of the conference will receive a refund less a $50 administrative fee. Cancellations 14–29 days prior receive a 50% refund. No refunds will be issued for cancellations received less than 14 days before the event. Substitutions of registrants are permitted at any time with prior written notification to the organizer; substitution does not guarantee transfer of any discounted rate.

Assumption of Risk and Liability Release: The registrant acknowledges participation in conference activities may involve travel and interaction with other attendees. The registrant assumes all risks and, to the fullest extent permitted by law, releases the conference organizer, its employees, volunteers, and agents from any liability for loss, damage, injury, or illness arising out of or in connection with attendance, except for liability resulting from gross negligence or willful misconduct.

Code of Conduct: The registrant agrees to abide by the conference code of conduct, to behave professionally, and to comply with instructions from conference staff. The organizer reserves the right to remove any participant whose behavior endangers others or disrupts the event, without refund.

Photo/Video Consent: I consent to be photographed, recorded, or interviewed during the conference and grant permission to the organizer to use such media for educational, promotional, or archival purposes without compensation. If you do not consent, check here:

Data Use and Privacy: The registrant acknowledges that personal information supplied in this form will be used for conference administration, emergency contact, and billing. The organizer will retain records as required for administrative purposes and will handle personal data in accordance with applicable data protection laws.

Academic Credit (If Applicable)

I request academic credit/continuing education documentation for attendance:

Certification

I certify that the information provided on this form is complete and accurate. By signing below I agree to the payment authorization, accept the cancellation and refund policy, consent to the liability release above, and acknowledge responsibility for compliance with conference policies. If the registrant is under 18 years of age, the undersigned parent or guardian certifies consent and assumes financial responsibility.

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