Primary Registrant Details Name*
First
Middle
Last
Address*
Continuing Education Credit Please tell us what type of continuing education credit you will be requesting and provide your license numbers. For legal credit, please include the 2-letter state abbreviation in front of your identification number (example: NY1234567). If you have multiple states, simply separate each entry by comma (example: NY1234567,NJ1234567).
Type of Continuing Education Credit
Social Registrant Details Only social registrants may attend conference-related breakfasts and receptions.
Communications will be sent directly to the social registrant, so please make sure to provide us with his/her/their email address.
I am registering a social registrant ($400): Name*
First
Middle
Last
Address*
May we include contact information for this registrant on a social registrant only list?*
Membership Status Check all that apply:* Conference Member Packages Non-Member Conference Packages Includes the Sunday and Monday evening receptions, technical education sessions, access to the attendee library of materials, and conference breakfasts & luncheons.
Full Conference - Administrator / Compensated Staff Executive for Affiliated Council Includes the half-day executive session on Wednesday; Council Leadership Conference sessions; materials; breakfast, lunch and the private executive-only dinner on Wednesday; and breakfast on Thursday (this registration is only available to paid staff members of affiliated councils ).
Full Conference - Administrator / Compensated Staff Executive for Affiliated Council Includes the half-day executive session on Wednesday; Council Leadership Conference sessions; materials; the Tuesday evening reception; breakfast, lunch and the private executive-only dinner on Wednesday; and breakfast on Thursday (this registration is only available to paid staff members of affiliated councils ).
Single Day Passes
Include sessions, access to the attendee library of materials, and conference-provided meals on the date(s) chosen. If you purchase a Monday Pass the Sunday evening reception is also included.Monday Pass Tuesday Pass Wednesday Pass Council Leadership Conference I would like to attend the “Dine Around” on Wednesday, October 22nd at 7:00 pm.* Connect with other council leaders at small group dinners following the Council Rewards Reception.
Conference Customization This field is hidden when viewing the form
Sponsored Bonus Sessions: Monday, October 20 - 7:15 am to 7:45 am This field is hidden when viewing the form
Sponsored Bonus Sessions: Tuesday, October 21 - 7:15 am to 7:45 am Events You Plan to Attend Supplemental Session Choices Learning Pod Choices (preferred) This year's conference offers a wide range of learning pod topics. Please select up to five choices :
Learning Pod Choices (backup) In the event that one of your Learning Pod choices is full, please select a separate backup option:
What time of year is most convenient for you to attend the NAEPC annual conference? In order to plan for future conferences, please let us let when you would be most likely to attend:
What market do you serve? What percentage of your clients fall into these ranges?
Please let us know what type of clients you serve so that we can present topics that are relevant to the market you serve. Social Registrant Package Includes the reception Sunday evening, Monday breakfast and reception, Tuesday and Wednesday breakfasts.
Social Registrant Event Attendance
Discounts Discounts Past President Events You'll Attend* Select all that apply.
Non-Member Discounts Non-Member Discount Code Option
Payment Method