NYSSLHA » Group Convention Registration

Group Convention Registration

When people from the same workplace register to attend Convention together, they are eligible to receive a discounted rate.

Discount Options *

5-10 Attendees ($5 discount each)

11-15 Attendees ($10 discount each)

16+ Attendees ($25 discount each)

Please check which one applies:

Organization/Employer Name: *

Contact Name: *

Company Address: *

Apt, suite, etc.

Country

City

State

Zip code

Contact Phone: *

Contact Email: *

Attendee #1 - Full Name

Attendee #2 - Full Name

Attendee #3 - Full Name

Attendee #4 - Full Name

Attendee #5 - Full Name

Attendee #6 - Full Name

Attendee #7 - Full Name

Attendee #8 - Full Name

Attendee #9 - Full Name

Attendee #10 - Full Name

Attendee #11 - Full Name

Attendee #12 - Full Name

Attendee #13 - Full Name

Attendee #14 - Full Name

Attendee #15 - Full Name

Attendee #16 - Full Name

Attendee #17 - Full Name

Attendee #18 - Full Name

Attendee #19 - Full Name

Attendee #20 - Full Name

Printable Registration Form (one per attendee)

Download Registration Form (page 5)

Upload Completed Convention Registration Form for Each Attendee

Accepted formats: pdf, png, jpeg, gif

Credit Card Type:

Visa

MasterCard

Discover

American Express

Credit Card Number:

Expiration Month

Expiration Year

Group Convention Registration

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