I am registering to attend:(Required) September 18 – Member rate – $125 September 18 – Non-member rate – $175 (includes a year of voting membership if eligible) Your name(Required) First Last Title(Required)Email address(Required) Phone(Required)Employer name(Required) Address(Required) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Are you planning on attending the reception on Wednesday evening – September 17?(Required) Yes No Special Dietary NeedsMailing A Check I would like to mail a check I am registering only – someone else in my organization will pay via credit card at a later time I qualify for the complimentary registration Total Credit Card(Required)Card Details Cardholder Name