TODO: AASC Conference Registration and Membership Dues Form Name First: Last: Organization Title: Organization: Contact Info Email: Phone: Address Business Home Street 1: Street 2: City: State: None AL AK AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC NE NH NJ NM NV NY ND OH OK OR PA RI SC SD TN TX UT VT VA WA WI WV WY Zip: Membership Are you a current AASC member? No Full Associate Student Would you like to apply for membership? No Yes as an Associate Yes as a Student Conference Registration Refer to membership and dues payment for status and price applied Status: Unknown membernon-member Early Bird (through )$300$340 Regular ( through )$325$365 Late (After and Onsite)$425$465 Awards Luncheon Additional Ticket(s) (One included with registration) - $ each 0 1 2 3 4 5 Banquet Additional Ticket(s) (One included with registration) - $ each 0 1 2 3 4 5 Membership Dues None Full Associate Student Allergies / Dietary Restrictions Please note any allergies, or dietary restrictions you or your guest(s) may have. Events Attending icebreaker (Cost included with registration) Yes No Interested in additional activity (Separate cost at event) Yes No Discount Enter discount code (if you have one) Discount will be applied at checkout Subtotal: Processing Fee: Total Cost: Payment You may pay online or mail a check. Online payment processes through PayPal. You don’t need to establish a PayPal account; you only need a debit or credit card. Please note: We can only provide refunds less processing expenses through 14 June 2019.