Contact Information First name Last name Email Street Address (Line 1) Street Address (Line 2) City State - Select -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Phone (include area code) Company/Organization Info Are you affiliated with Penn State University? - Select -YesNo PSU Affiliation - Select -FacultyStaff Company/Organization Name Is your company/organization a non-profit organization? - Select -YesNo Is your company/organization a sponsor of this year's ERIE Conference? - Select -YesNo For what amount? - Select -Silver ($1,000)Gold ($5,000)Platinum ($10,000) Complimentary Reservations: Silver Level Silver sponsors receive 3 complimentary registrations to the conference. Please enter the names of those who will be accepting the complimentary tickets. (You may include yourself as one of the individuals receiving a complimentary registration.) Silver Ticket #1 First Name Last Name Silver Ticket #2 First Name Last Name Silver Ticket #3 First Name Last Name Complimentary Reservations: Gold Level Gold sponsors receive 6 complimentary registrations to the conference. Please enter the names of those who will be accepting the complimentary tickets. (You may include yourself as one of the individuals receiving a complimentary registration.) Gold Ticket #1 First Name Last Name Gold Ticket #2 First Name Last Name Gold Ticket #3 First Name Last Name Gold Ticket #4 First Name Last Name Gold Ticket #5 First Name Last Name Gold Ticket #6 First Name Last Name Complimentary Reservations: Platinum Level Platinum sponsors receive 10 complimentary registrations to the conference. Please enter the names of those who will be accepting the complimentary tickets. (You may include yourself as one of the individuals receiving a complimentary registration.) Platinum Ticket #1 First Name Last Name Platinum Ticket #2 First Name Last Name Platinum Ticket #3 First Name Last Name Platinum Ticket #4 First Name Last Name Platinum Ticket #5 First Name Last Name Platinum Ticket #6 First Name Last Name Platinum Ticket #72 First Name Last Name Platinum Ticket #8 First Name Last Name Platinum Ticket #9 First Name Last Name Platinum Ticket #10 First Name Last Name Lunch The conference fee includes continental breakfast, lunch, and refreshments during the break. Do you have any dietary restrictions? Do you have any dietary restrictions? - Select -YesNoOther… Enter other… Please provide information about any food-related allergies that you have (if applicable). Parking Although you will not be charged for parking, please let us know if you will be driving to our conference so that we can plan for an appropriate number of parking spaces. Will you be parking on campus? Will you be parking on campus? - Select -YesNoOther… Enter other… Conference Fee/Payment Instructions The conference fees are as follows: Early-bird special (registration by July 7): $135.00 Regular registration (registration after July 7): $150.00 Early-bird for non-profits (registration by July 7): $108.00 Regular registration for non-profits: (registration after July 7): $120.00 Staff / faculty registration: $50 To make payment, please: Use one of these credit cards: Visa, MasterCard, and Discover. Click the Submit button. You will be taken to your cart to review the charges. After clicking 'Pay and complete purchase', then you will be forwarded to the Converge e-Pay site to complete your credit card transaction. Registration Type Early bird special (registration by July 7): $135.00 Regular registration (registration after July 7): $150.00 Early-bird for non-profits (registration by July 7): $108.00 Regular registration for non-profits (registration after July 7): $120.00 CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Submit
