Spring Conference Educational Attendee Registration I am registering to attend:(Required) April 30 session ONLY – OSHA Topics/Lock Out Tag Out/ARC Flash – Member/Non-member rate – $75 May 1 session ONLY – General Conference Sessions – Member rate – $125 May 1 session ONLY – General Conference Sessions – Non-member rate – $175 (includes a year of voting membership in PSHFE if eligible) BOTH April 30 & May 1 sessions – Member rate – $200 BOTH April 30 & May 1 sessions – Non-member rate (includes a year of voting membership in PSHFE if eligible) – $250 May 1 session – Complimentary (available to those who have been in healthcare facilities mgmt. less than 5 years and have never attended a PSHFE conference) – $0 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 Will you need a certificate of completion for ASHE CEC credits?(Required) Yes No Are you planning on attending the reception on Thursday evening – April 30?(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
