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DHASNY 97th Empire Conference/Annual Session Registration Form

November 3-5, 2017 - Crowne Plaza, White Plains, NY

Association Member ID:
Is this your first conference?
Name:*
Address:*
Phone:*
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E-mail:*
Registration type:*

* Not yet a member? Use the member rate if you join now.
** Pre-Registered Table Clinic Participants are exempt from paying a Registration Fee. 

Event Registration  Please check the box for events you will attend.

Conference Registration entitles your entry into Continuing Education Courses, Exhibitors’ Hall on Friday evening (new!) and on Saturday morning, Friday and SundayHouse of Delegates Meetings, Friday morning Candidates’ Forum and Reference Committee Testimony Sessions, Student Table Clinics, Silent Auction, and Sunday morning Installation of Officers and Directors.

Specially ticketed events:Current Issues Luncheon (Course #7) and President’s Reception/Dinner on Saturday night are not included in registration fee. Please see Special Events below to register.*

Courses:

Special Events:
Total Registration and Special Event Fees (please use numbers only, no periods):*
 $ 

(Course and special events tickets will be in your registration packet. Stop at Registration Desk when you arrive.)

Cancellation Policy: Written notice of cancellation accepted if postmarked by Oct. 1, 2017. Written cancellations postmarked after Oct. 1 subject to a $30.00 processing fee. Sorry, cancellations after Oct. 21 cannot be honored. 

If you have a disability and require special assistance, please inform DHASNY by filling in the box below, or email exdir@dhasny.org at least 2 weeks prior to the conference. 

Disability requirements:

NOTE: When you click on Submit, you will be taken to PayPal to complete your payment securely. You can use your PayPal account, or use your credit or debit card if you don't have a PayPal account. When you are finished with your payment, you will receive a confirmation email.

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