Registration

PHA CONFERENCE REGISTRATION - For Credit Card Payment ONLY

August 13 - 15, 2024

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)	I have been at this job for 1 year or less I have been at this job for 15 years or more I make purchasing decisions for my agency

Select Category (not for spouse or child)	Exec. Director Maintenance Other PHA Staff Commissioner Other (for non-PHA registrants)
	21 years of age or older
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)	I have been at this job for 1 year or less I have been at this job for 15 years or more

Select Category (not for spouse or child)	Exec. Director Maintenance Other PHA Staff Commissioner Other (for non-PHA registrants)
	21 years of age or older
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)	I have been at this job for 1 year or less I have been at this job for 15 years or more I make purchasing decisions for my agency

Select Category (not for spouse or child)	Exec. Director Maintenance Other PHA Staff Commissioner Other (for non-PHA registrants)
	21 years of age or older
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)	I have been at this job for 1 year or less I have been at this job for 15 years or more I make purchasing decisions for my agency

Select Category (not for spouse or child)	Exec. Director Maintenance Other PHA Staff Commissioner Other (for non-PHA registrants)
	21 years of age or older
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)	I have been at this job for 1 year or less I have been at this job for 15 years or more I make purchasing decisions for my agency

Select Category (not for spouse or child)	Exec. Director Maintenance Other PHA Staff Commissioner Other (for non-PHA registrants)
	21 years of age or older
Registration	Registration covers all receptions, luncheons, parties
	Indicate number registering
PHA Staff or Commissioner	x $600 =
Nonmember Registration	x $700 =
Spouse (all functions)	x $175 =
Child over 3 (all functions)	x $175 =


SUBTOTAL
3% handling charge
TOTAL

REFUNDS: cancellation by July 30 - full refund cancellation by July 30 - August 3, refund minus $100 fee cancellation after August 3 NO REFUND