2018 PAIU Student Services Conference Registration


Attendee Name*

First Name

Last Name


Please select your Organization*


Affiliation*


LEA Affiliation*

District or LEA


Job Title*


*** IU 21 will be offering Act 48 credit for participation in the 2018 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 IU email address is required in order to complete conference registration)


Billing Address*
Home Address
Work Address

*** Home Address is required to receive Act 48 credits ***



City

State

Zip Code


Cell or Work Phone Number*


Registration Options*


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.


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 Wednesday, October 17th, 2018. No refunds will be granted for requests received AFTER October 17th, 2018, since PAIU becomes liable for food and beverage costs after guaranteed counts (based on the number of registered attendees) are provided to the venue.NO SHOWS THAT HAVE REGISTERED BUT HAVE NOT PAID ARE STILL LIABLE FOR THE REGISTRATION FEE. A REGISTERED ATTENDEE WHO DOES NOT CANCEL IS STILL LIABLE FOR THE REGISTRATION FEE. The registration fee includes all educational sessions and materials, and the meals listed. It does NOT cover lodging or travel expenses.