2022 Conference - Online Registration Conference Registration Name(Required) First Last Job Title Home Address(Required) Street Address Address Line 2 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 Home Phone(Required)Home Email(Required) I'm registering as a facility Yes Facility or Company Name Facility or Company Address Street Address Address Line 2 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 Work PhoneWork Email Local Association County(Required) First IAPA Conference?(Required)Please Select an OptionYesNoWould you like an email confirmation?(Required)Please Select an OptionYesNoAre you an IAPA Member?(Required)Current IAPA members save on conference feesPlease Select an OptionYesNoJoin TodayTake advantage of the Member Rate by Joining Today. By checking the box below, you will be able to take advantage of IAPA member pricing for the conference as well as a discounted membership rate. You will receive a link to the membership registration form in your email. The membership registration form must be completed in order to keep your IAPA member pricing for the conference.I would like to sign up for an IAPA membership Yes IAPA Member Conference FeesIAPA Member Conference Fees(Required)Please select the appropriate choicePlease Select an OptionWednesday Intensive (6 CE’s with lunch) - $85Thursday-Only Registration (6 CE’s with lunch) - $135Friday-Only Registration (4 CE’s with lunch) - $110All 3 Days - $285Wednesday and Thursday RegistrationThursday and Friday Registration (10 CE’s and 2 Meals) - $235Administrators Attending Thursday and Friday with a staff member - $100Retired Board Member Rate Thursday and Friday - $100Non-Member Conference FeesNon-Member Conference Fees(Required)Please select the appropriate choicePlease Select an OptionWednesday Intensive (6 CE’s with lunch) - $110Thursday-Only Registration (6 CE’s with lunch) - $185Friday-Only Registration (4 CE’s with lunch) - $160All 3 Days - $360Wednesday and Thursday RegistrationThursday and Friday Registration (10 CE’s and 2 Meals) - $310Meal SelectionThe following meals are included in the conference registration price, but you must sign up to be included in meal totals.Meals you are planning to attend(Required)Please select all that apply Wednesday Lunch Thursday Lunch Friday Lunch Select AllPlease indicate special dietary requirementsGuest Meal TicketsGuests not registered for the conference must have a ticket for all meals. Please indicate # of tickets needed.Wednesday Lunch Quantity Price: $20.00 Quantity Thursday Lunch Quantity Price: $26.00 Quantity Friday Lunch Quantity Price: $26.00 Quantity Breakout SessionsBreakouts sessions are listed below. For descriptions of the specific Breakouts, please refer to the ITINERARY section of the brochure. Please indicate your 1st choice for each time period. Every attempt will be made to give each participant their first choice. However, decisions will be made on a first come basis, so register early. If you are registering for a single day, you will have admittance to the Breakouts listed for that day only.Wednesday October 5th - 9:00AM - 4:30PM(Required)Intensive – Redwood/Sierra (Pam Goff and Deb Greiner)Please Select an OptionI will attendI will not attendThursday October 6th - 9:00AM - 10:30AM(Required)Hawthorne Room (Lisa Olson & Debra Joy Hart) Please Select an OptionI will attendI will not attendThursday October 6th - 10:45AM - 12:15PM(Required)Please Select an OptionA – Jackie Shaffer – “Towel Folding for Fun or Function” – Denali/Glacier Room (Note: This session is limited.)B – Kim Mead – “Designing Engaging Programs Incorporating the Seven Dimensions of Wellness” - Redwood/ Sierra RoomThursday October 6th -1:30PM - 3:00PM(Required)Please Select an OptionC – Janet Sand – “Modifying Activities Through Our Seasons” - Denali/Glacier RoomD – Kenny Shuman – “Fundraising – Your Solution to Phenomenal Programs” – Redwood/Sierra RoomThursday October 6th - 3:15PM - 4:45PM(Required)Please Select an OptionE – Tammy Bitner – “The Season for Growing” – Denali/Glacier RoomF – Tim Strand/Kim Mead/Misty Duncan – “Engagement Technology & the Dimensions of Wellness”Redwood/Sierra RoomFriday October 7th - 9:00AM - 10:30AM(Required)Please Select an OptionG - Joe Agnello - “When Grief Hits You – Theory & Practice”Denali/Glacier RoomH – Geri Wozniak - “Motivating Yourself & Your Team Through Seasons of Change” Redwood / Sierra RoomFriday October 7th - 10:45AM - 12:15PM(Required)Please Select an OptionI - Joe Agnello - “Compassion Fatigue: A Prescription for Regaining Energy & Balance at Work” - Denali/Glacier RoomJ - Lisa Olson - “Passive Activities & the Busy Professional” - Redwood / Sierra RoomFriday October 7th - 1:30PM - 2:45PM(Required)Hawthorne Room (Denise Spihlman)Please Select an OptionI will attendI will not attendPayment InformationRefund Policy: Cancellations received on or before 9/15/22 will receive full refund. Cancellations received 9/16/22– 9/21/22 will receive a refund less a $50 processing fee. Cancellations received on or after 09/22/22 will not be refunded.Total Credit CardCard Details Cardholder Name