H.I.T. CONFERENCE REGISTRATION
First Name:
*
Last Name:
*
Title/Rank:
Agency:
*
Phone Number:
*
Email:
*
Work Address:
*
TCOLE PID #:
*
City/State/Zip Code:
*
County:
*
Association Status
*
Please Select
Regular Member
Lifetime Member
Board Member
Payment Method
*
Personal Check
Agency Check
Cash at door
Purchase Order
PayPal
Association Status
*
Life Member
Regular Member
Board Member
Vendor
Purchase Order Number:
Preferred Payment
Please Select
Credit Card
PayPal
Check By Mail
Cash At Door
Purchase Order
Pay Later Conference Options
Please Select
Conference Registration - Lifetime Member ($200 per registrant)
Conference Registration - Non-Lifetime Member ($300 per registrant)
My Conference Registration
*
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Conference Registration - Lifetime Member
$
200.00
Quantity
1
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10
Conference Registration - Non-Lifetime Member
$
300.00
Quantity
1
2
3
4
5
6
7
8
9
10
Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
Submit
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