UNDER THE PAYMENTS CHOICE AT THE BOTTOM OF THE FORM, YOU MAY CHOOSE EITHER “PAYPAL CHECKOUT” (If you have a PayPal account) OR “CREDIT CARD” (To pay directly by credit card).

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Address

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Address Line 2

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

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Name of Attendee or other comment

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Checkbox Items

• Student – $5.00
• Academic – $20.00
• Professional – $30.00

PayPal Commerce *

PayPal CheckoutCredit Card

Card Number

Expiration Date

Security Code

Card Holder Name

Submit