Conference Registration – Alabama Association For Public Continuing And Adult Education

Alabama Adult Education Conference Registration Form

"*" indicates required fields

Adult Education Program Name*

Name*

First Last

Work Address*

Street Address Address Line 2 City State ZIP Code

Contact Email*

Contact Phone Number*

Conference Sessions

The conference is Wednesday, June 14 - Friday, June 16, 2023.

Enter the details of each of your conference attendees.

Enter one name per line, then click the + symbol to add more attendees.

First Name

Last Name

Phone Number

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Will you have pre-conference attendees?

Yes

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Pre-Conference Attendees

Pre-conference is Tuesday, June 13, 2023. Each session is limited to 30 attendees.

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Enter the details of each of your pre-conference attendees, including which session (Math 1, Math 2, or ESL) they will attend.

First Name

Last Name

Phone Number

Session

Payment Method

Which payment method will you be using?*

Purchase Order

Debit/Credit Card

Check

Enter your purchase order number here, if available.*

If you do not have a PO number yet, enter "N/A" in the space below. When you do receive your purchase order number, email the number, your name, your organization name, and payment amount to treasurer@alapcae.com.

Enter your check number here, if available.*

If you do not have a check number yet, enter "N/A" in the space below. When you receive it, email the number, your name, your organization name, invoice number, and payment amount to treasurer@alapcae.com.

INSTRUCTIONS FOR CHECK PAYMENTS After you receive your invoice from the ALAPCAE Treasurer:

Make check payable to ALAPCAE.
Enclose a copy of invoice with payment.
Mail to PO Box 573, Sulligent, AL 35586

Number of Attendees

Price: $275.00

Total

Credit Card*

Card Details

Cardholder Name

Card Billing Address*

Street Address Address Line 2 City State ZIP Code

IMPORTANT:

No refunds will be issued after the final list of attendees is submitted.

Questions: info@alapcae.com

Thank you for your understanding.

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Address

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Alabama Adult Education Conference Registration Form

Conference Sessions

Pre-Conference Attendees

Payment Method

INSTRUCTIONS FOR CHECK PAYMENTS After you receive your invoice from the ALAPCAE Treasurer:

Make check payable to ALAPCAE.

Enclose a copy of invoice with payment.

Mail to PO Box 573, Sulligent, AL 35586

IMPORTANT:

No refunds will be issued after the final list of attendees is submitted.

Questions: info@alapcae.com

Thank you for your understanding.