Conference Fees (Meals are included in registration fees)
Professional (PCPA Members) Select all that apply (Hold down the CTRL key when selecting more than one choice) Full Conference Prof Member Registration $185 Sunday Only Prof Member $50 Monday Only Prof Member $95 Tuesday Only Prof Member $40 Membership (New or Renewal) $25 Not Applicable	Full Time Grad Student Select the option that applies Full Conference Registration Grad Member $85 Full Conference Registration Grad Non-Member $85 Not Applicable
Professional (Non-PCPA Members) Select all that apply (Hold down the CTRL key when selecting more than one choice) Full Conference Prof Non-Member Registration $220 Sunday Only Prof Non-Member $60 Monday Only Prof Non-Member $110 Tuesday Only Prof Non-Member $50 Not Applicable *non-members may become members for $25.00 and pay the member rates for the conference*	Full Time Grad Student Attending Single Day Select the option that applies Sunday Only Non Member Grad Student No Charge Monday Only Non Member Grad Student No Charge Tuesday Only Non Member Grad Student No Charge Not Applicable
Total Amount
Please Indicate Your Meal Choices
Sunday dinner  choice Vegetarian Lasagna European Chicken Breast	Monday dinner  choice Stuffed Peppers Pot Roast

 Please list any dietary needs, physical and/or learning accomodations you will require:

Are you interested in volunteering at the conference?  Yes No

Are you a first time PCPA Conference attendee?  Yes  No 

Are you interested in participating in the Mentor/Mentee program?      Yes      No 
 
                                As a Mentor    
                                As a Mentee    

Please click the Submit/Send button to begin the process to register for the conference.  The
information you have listed above will be fowarded to the Conference Committee, however you
will still need to finalize your registration by sending in your conference fees.   You may
print this page and submit it  with your check or your institution's Purchase Order to :

                                                   Amber N. Valentine
                                                   Acting Coordinator, Student Life/Student Conduct
                                                   Indiana University of Pennsylvania
                                                   201 Pratt Drive, 307 Pratt Hall
                                                   Indiana, PA 15705
                                                   Phone: 724.357.1264