Register

Attendee Pre-Registration
January 29 - January 31, 2012 | Lake Charles

The conference committee is seeking both silent auction items and scholarship applicants. You can register online below or use our printable registration form. Pre-Registration will close Tuesday, January 25, 2012. You may still register with payment at the registration desk in Lake Charles.

PRE-REGISTRATION FORM

Name
First Last E-mail (for confirmation, invoice, & receipt)

Job Title         CPRP?     CTRS?
Note that your name, job title, and organization will be printed on your badge as typed.


Organization

Address

City, State, Zip                                                                  Daytime Phone
___________________________________________________________________________

Please select or create your registration package!

FULL PACKAGE REGISTRATION: Includes educational sessions, the opening social, the exhibit
hall social, all breaks, and the LRPA Awards Banquet. Non-Member Full-Package registration
comes with a complimentary one-year membership for first-time attendees!

	Payment or PO Received By 1/25/12	Payment or PO After 1/25/12 (On-Site)
LRPA Professional Member*	$225	$250
TRSW Member*	$225	$250
LRPA Student Member	$55	$80
Other Member (CBM, Retired)	$100	$125
Non-Member Professional*	$275	$300
Non-Member Student	$75	$100

* CEU credit fees are included in professional registration.

DAILY PROFESSIONAL PACKAGE: ONLY INCLUDES CEUs.
Daily registrants will pay an additional fee if they wish to attend social events and meal functions.

	Payment or PO Received By 12/31/11	Payment or PO Received After 1/1/12
PROFESSIONAL: Sunday, January 29	$50	$60
PROFESSIONAL: Monday, January 30	$75	$85
PROFESSIONAL: Tuesday, January 31	$75	$85
STUDENT: Monday, January 30	$25	$35
STUDENT: Tuesday, January 31	$25	$35

* CEU credit fees are included in professional registration.

ADDITIONAL TICKETS:
Monday All-Conference Social..........................$25 each. Number of Tickets
Tuesday Awards Luncheon ..............................$30 each. Number of Tickets
Please note that full-package registration includes one (1) awards banquet and one (1) all-conference social ticket.

PLEASE RSVP:

Zydeco Fitness | Community Event Planning 101 (Session #B1)
Adventures in Low Elements (Session #B12)

SPECIAL ACCOMMODATIONS:
If you require special services in order to fully participate, please provide a written description (i.e., special diet, wheelchair transportation). Advance notification is required.

Purchase Order: (optional) This will lock in the current pre-registration rate.

CANCELLATION POLICY: Requests for refunds must be made in writing to the LRPA administrative office. Requests received before 1/10/2012, are subject to a $25 penalty. No refund requests will be accepted after this date.

629 North Main Street • Hattiesburg, MS 39401 (800) 810-3882 info@lrpa.net