SEPA 2014 Delegate Registration Form

Please fill out the form below to begin the registration process for the SEPA 2014 annual conference. All fields in bold are required.

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Personal Information
Middle Initial
Preferred Name
Address Line 2
State
ZIP Code
Country
Work Phone
Fax Number
Mobile Phone
Additional Email
Registration Specifics
Student Registrant Information
If you would like to use a credit card to pay for your conference registration and/or SEPA dues, we will email you a credit card authorization form. Once filled out, the form can be returned via email, fax, or post.
There will be a $5 administrative fee applied to all standard registrations and a $2.50 administrative fee applied to all student/part-time registrations.
Food & Lodging
Dietary Restrictions
Guest/Spouse Registration
Name
In attendance (Please check all that apply):
Dietary Restrictions
Please contact us to separately invoice you for guest/spouse registration. By default, will we NOT include these fees on your standard invoice.
Additional Comments

 

Want more info? Contact us.

General Information:
Derek Demeter407.708.2409

School Field Trips:
Michael McConville407.708.2421

Media Requests
Derek Demeter407.708.2409

Seminole State General Contact Information