I am registering to attend:(Required) April 24 session ONLY – Firestop Education & FIT Training – Member/Non-member rate – $75 April 25 session ONLY – Member rate – $125 April 25 session ONLY – Non-member rate (includes a year of voting membership in PSHFE if eligible) – $175 April 24 & 25 sessions – Member rate – $200 April 24 & 25 sessions – Non-member rate (includes a year of voting membership in PSHFE if eligible) – $250 April 25 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 Are you planning on attending the reception on Thursday evening – April 24?(Required) Yes No Special Dietary NeedsMailing A Check I would like to mail a check I qualify for the complimentary registration Total Credit Card(Required)Card Details Cardholder Name Δ
