Register for the Conference - Step 1

Registration fees are as follows:

Attendee, 1 Day - $130
Attendee, 2 Days - $160
Student, 1 Day - $75
Student, 2 Days - $110

Registration fees after June 22nd are as follows:

Attendee, 1 Day - $130
Attendee, 2 Days - $160
Student, 1 Day- $75
Student, 2 Days- $110

You may pay either by purchase order, check or with a credit card.

Please enter the following information (required information is in bold text):
First Name:
Last Name:
Company:
Address:
City:
State:
ZIP:
Phone:
Fax:
E-mail:

Please choose a registration option:

Regular Attendee - 2 Days ($160)
Regular Attendee - 1 Day, October 10, 2007 ($130)
Regular Attendee - 1 Day, October 11, 2007 ($130)
Student - 2 Days ($110)
Student - 1 Day, October 10, 2007 ($75)
Student - 1 Day, October 11, 2007 ($75)

This is my first time attending Program Sharing

Special Requests:

Vegetarian Meal:

Please indicate any other special needs or comments here

Please select payment method

I will pay with a credit card. (MPRC will call for my credit card information)
I will pay with a check or PO. (MPRC will invoice you) PO Number:

Please Note: Registration will be due in full by October 10, 2007.

Cancellation Policy: Registration fees, minus a $30 administration fee, will be waived if cancellation is made in writing to the Minnesota Prevention Resource Center's office on or before September 28, 2007. Fees are non-refundable after this date, but registration can be transferred to another person.

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	The Minnesota Prevention Resource Center (MPRC) is a project of the Minnesota Institute of Public Health with funding provided through a grant from the Alcohol and Drug Abuse Division (ADAD), Minnesota Department of Human Services
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