2017 PAIU Conference Registration


Attendee Name*

First Name

Last Name


Intermediate Unit*


Please indicate the job-alike group with which you participate*




Job Title*


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


Phone Number*


Cell Phone Number


*** IU 21 will be offering Act 48 credit for participation in the 2017 PAIU Conference. If you are interested in receiving Act 48 credit, please enter and confirm your PPID ***

PPID

Confirm PPID


Registration Options*






Do you need any special accommodations?


An invoice will be sent by regular mail after submission of this registration form.

A registered conference attendee may, upon written request, receive a full refund of a paid registration fee as long as the request is received by the PAIU office by May 19, 2017.