CONVENTION REGISTRATION

!!! THIS FORM SHOULD ONLY BE USED IF YOU ARE PAYING ONLINE.  IF YOU USE THIS FORM AND DO NOT PAY ONLINE YOU WILL NOT BE REGISTERED FOR THIS EVENT !!!

Hilton at UAB
Birmingham, AL

Friday, September 27, 2019 through Sunday, September 29, 2019

Registration Fee (Pre-registered and onsite) $115.00 Per Person

First Name:*
Last Name:*
Address:*
City:*
State:*
Zip Code:*
Phone:*
E-mail:*
Activities you plan to participate in:
Registration:*
Accessibility Needs:*

Please complete the payment process on PayPal.  YOU ARE NOT REGISTERED UNTIL THE PAYMENT PROCESS IS COMPLETED.

Total:
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