2017 PAIU Student Services Conference Registration


Attendee Name*

First Name

Last Name


I am registering as a:*
Full Registration Fee - $325.00

Please select your Organization*


Affiliation*


LEA Affiliation*

District or LEA


Role or Title*


*** Act 48 credit is available for participation in the 2017 PAIU Student Services Conference. If you are interested in receiving Act 48 credit, please enter and confirm your PPID. ***

PPID

Confirm PPID


Email Address* (A valid email address is required in order to complete conference registration)


Billing Address*
Home Address
Work Address




City

State

Zip Code


Cell or Work Phone Number*



In the unlikely event of an emergency please help us help you by providing the name and telephone number of the person we should contact.


Do you require accommodations for a disability? If so, please specify.


Do you have any food allergies, medicine allergies, or special dietary needs? If so, please specify.


Hotel reservations must be made separately. Please visit the Hotel Registration Page for more information on making your reservations at Sheraton Station Square.


Cancellation Policy: A registered conference attendee may, upon written request via email, receive a full refund of a paid registration fee as long as the request is received by the PAIU office by Friday, October 20, 2017.

THANK YOU FOR YOUR SUPPORT OF THE STUDENTS AND SCHOOLS OF PENNSYLVANIA.
Please see your confirmation email for invoice.

Please make checks payable to:

PAIU
ATTN: 2017 PAIU SS Conference
587 James Drive
Harrisburg, PA 17112-2273