Alabama Adult Education Conference Registration Form "*" indicates required fields Adult Education Program Name*Please Select:Not Affiliated with an Alabama Adult Education programAutauga County Family Support CenterBevill State Community CollegeBishop State Community CollegeCalhoun State Community CollegeCentral Alabama Community CollegeChattahoochee Valley Community CollegeCoastal Community CollegeDrake State Community and Technical CollegeE. H. Gentry FacilityEnterprise State Community CollegeGadsden State Community CollegeGoodwill Industries/Easter Seals of the Gulf Coast, Inc.Ingram State Technical CollegeJefferson State Community CollegeLawson State Community CollegeLurleen B. Wallace Community CollegeNortheast Alabama Community CollegeNorthwest-Shoals Community CollegeReid State Community CollegeShelton State Community CollegeSouthern Union State Community CollegeTrenholm State Community CollegeWallace Community College - HancevilleWallace Community College - SelmaWallace Community College - DothanName* First Last Work Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Contact Email* Contact Phone Number*Conference SessionsThe 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 NameLast NameEmailPhone Number Add RemoveHiddenWill you have pre-conference attendees? Yes No HiddenPre-Conference AttendeesPre-conference is Tuesday, June 13, 2023. Each session is limited to 30 attendees.HiddenEnter the details of each of your pre-conference attendees, including which session (Math 1, Math 2, or ESL) they will attend.First NameLast NameEmailPhone NumberSession Add RemovePayment MethodWhich 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 Quantity Price: $275.00 Quantity Total Credit Card*Card Details Cardholder Name Card Billing Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific 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.HiddenTags 2023 Conference Registrant HiddenStatus