2010 Conference & Workshops Registration Form

Please Select Number of Registrants:

REGISTRANT #1

Name Badge and Contact Information

* First Name:
* Last Name:
Badge Name:
Job Title:
Department/Unit:
Institution/Organization:
* Phone:
Alternate Phone:
* Email:
* Verify Email:
* Mailing Address:
* Mailing City:
* Mailing State:
* Mailing Zip Code:
	Click here to Copy Mailing Address to Billing Address
Billing Address:
Billing City:
Billing State:
Billing Zip Code:

2010-11 HPEA Membership Dues/Renewal

Each paid conference fee includes a complimentary 1-year H-PEA membership

Area(s) of specialization in evaluation:

May we include your name, email, title, organization,
and area(s) of specialization in the online H-PEA member directory? Yes No

Conference Registration

* Conference Selection:

Lunch Preference:

Non Vegetarian Vegetarian

Pre-Conference Workshops - Thursday

A) Thursday Morning Workshop (B. Cousins):

ATTENTION: Brad Cousins' workshop is FULL. Registrations no longer accepted.

B) Thursday Afternoon Workshop (L. Datta):

ATTENTION: Lois-ellin Datta's workshop is FULL. Registrations no longer accepted.