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2012 GA Professional Day Registration Form

PLEASE READ THIS CAREFULLY! Use this form to register for LREDA Professional Day at GA in Phoenix on Wednesday, June 20 at the Hyatt Regency. This year we will have our Annual Meeting and luncheon during Professional Day. Please refer to the flyer for the schedule. The luncheon menu will be posted on the website when we have that information. IF you wish to pay by credit card, the deadline is June 10. IF you wish to pay by check (U.S. funds only), the postmark deadline is June 1 and we must receive it by June 10. We accept your online registration as a commitment on your part and expect that you will send your check in a timely manner. We know that sometimes the payment process from congregations can be slow, and mail to Canada can also sometimes take longer than expected. If your check does not arrive by June 10, we will assume you have changed your mind. Registration confirmations are sent out as registrations are received, so if you think you have registered in a timely manner and have no confirmation yet, please check with the Administrator. Thank you. See you in Phoenix!

Salutation (optional):

First name: *

Last name: *

Credentialing or Position (optional for nametag):

Street Address: *

City: *

State or province: *

Postal code: *

Preferred email address: *

Preferred phone number: *

I am a LREDA member: *

Yes

Your LREDA Chapter: *

Is there anything we can do to accommodate any special needs you may have?:

Fee payment Professional Day, June 20th : *

LREDA Member: Professional Day fee $75 (includes lunch but not breakfast) postmarked by June 1, received postal mail OR web payment by June 10

Non-member: Professional Day fee $95 (includes lunch but not breakfast) postmarked by June 1, received postal mail OR web payment by June 10

Good Officer/Chapter Chair:

I am attending Professional Day as a Good Officer. You MUST be either a current Good Officer or nominated by your chapter and approved by the LREDA Board PRIOR to GA. (You will receive a stipend of $100 on site.)

I am attending Professional Day as Chapter Chair/Convener or Chapter Representative authorized by my LREDA chapter. (You will receive a stipend of $100 on site.)

Food needs:

Gluten-free

Vegetarian

Vegan

List any life-threatening allergies only:

Your contribution of $2 to help defray the cost of processing: $

Your contribution to the LREDA Scholarship Fund: $

Your contribution to the LREDA Endowment Fund: $

Your contribution to the Sophia Lyon Fahs Lecture Fund: $

Your total payment: $

Payment method:

I am paying by credit card. Hit Submit and see the confirmation page for further directions. (Sorry, American Express is not currently accepted)

I am paying by check in U.S. funds. Hit Submit, print out the confirmation page, and mail it along with your check (address is on the confirmation page). MUST BE POSTMARKED BY JUNE 1.

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