PHA CONFERENCE REGISTRATION - For Credit Card Payment ONLY

August 13 - 15, 2019

PLEASE READ THIS BEFORE FILLING OUT FORM

1. Use this form to register up to 5 people and their spouses and/or children.
2. The online registration is ONLY for PHAs wanting to pay with a credit card.
3. After the earlybird registration deadline of July 15, member and non-member registrations will go up $100.
4. To cover our extra cost for taking credit cards, a 3% handling charge will be added to your total registration amount.
 
Registrant Information
PHA/COMPANY
PHONE
EMAIL
 
Registrant #1
NAME
TITLE
BADGE FIRST NAME
BADGE NAME SPOUSE (if registering)
BADGE NAME CHILD (if registering)
BADGE NAME CHILD (if registering)
EMAIL

Job History (PHA Registrants only)



   
Select Category (not for spouse or child)



   
Registrant #2
NAME
TITLE
BADGE FIRST NAME
BADGE NAME SPOUSE (if registering)
BADGE NAME CHILD (if registering)
BADGE NAME CHILD (if registering)
EMAIL
   
Job History (PHA Registrants only)

   
Select Category (not for spouse or child)



   
Registrant #3
NAME
TITLE
BADGE FIRST NAME
BADGE NAME SPOUSE (if registering)
BADGE NAME CHILD (if registering)
BADGE NAME CHILD (if registering)
EMAIL
   
Job History (PHA Registrants only)

   
Select Category (not for spouse or child)



   
Registrant #4
NAME
TITLE
BADGE FIRST NAME
BADGE NAME SPOUSE (if registering)
BADGE NAME CHILD (if registering)
BADGE NAME CHILD (if registering)
EMAIL
   
Job History (PHA Registrants only)

   
Select Category (not for spouse or child)



   
Registrant #5
NAME
TITLE
BADGE FIRST NAME
BADGE NAME SPOUSE (if registering)
BADGE NAME CHILD (if registering)
BADGE NAME CHILD (if registering)
EMAIL
   
Job History (PHA Registrants only)

   
Select Category (not for spouse or child)



   
Registration - By July 15 Registration covers all receptions, luncheons, parties
  Indicate number registering
PHA Staff or Commissioner x $500 =
Nonmember Registration x $600 =
Spouse (all functions) x $125 =
Child over 3 (all functions) x $125 =
   
 
SUBTOTAL
3% handling charge
TOTAL

REFUNDS: cancellation by July 29- full refund
cancellation by July 30 - August 2, refund minus $85 fee
cancellation after August 2- NO REFUND