Registration 49th Annual AZilg Conference Registration October 25, 2024 Registration Cost Conference Registration: Members ($199) / Non-Members ($249) REGISTRATION - AZilg Conference 2024 Conference Registration for one or more attendees. 10% Group Discount applied when registering 5 or more! How many people are you registering for the conference?*Please enter a number from 1 to 9.Send email to info@azilg.org if registering more than 9 attendeesREGISTRATIONSPlease provide name and email of each attendeeRegistration #1: Name* First Last Registration #1: Email Registration #2: Name First Last Registration #2: Email Registration #3: Name First Last Registration #3: Email Registration #4: Name First Last Registration #4: Email Registration #5: Name First Last Registration #5: Email Registration #6: Name First Last Registration #6: Email Registration #7: Name First Last Registration #7: Email Registration #8: Name First Last Registration #8: Email Registration #9: Name First Last Registration #9: Email Name on Credit Card* First Last Organization* Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Enter Email Confirm Email Receipt will be sent to this emailSpecial Accommodation Requests Cancellation Policy• Cancellation requests can be made at: info@azilg.org • Cancellations will be assessed a $25 administrative fee now through September 30, 2024 • Fifty percent (50%) of the registration will be refunded for cancellations received September 1 through September 30, 2024 • Cancellations received on October 1, 2024 and after are nonrefundable • Refunds (if applicable) will be issued within 7 days of cancellation • Registrations are transferable to another colleague at any time prior to refund • Credit of registration fees cannot be applied toward future conferencesMEMBER REGISTRATION2024 AZilg paid membership will be verified; if not a paid member, additional balance due will be collected at registrationHow many 'Member' Registrations? If none, put a zero.*Please enter a number from 0 to 9.Member Registration for:Select (if applicable)10/25: Conference (Includes JAG Luncheon)NON-MEMBER REGISTRATIONHow many 'Non-Member' Registrations? If none, put a zero.*Please enter a number from 0 to 9.Non-Member Registration for:Select (if applicable)10/25: Conference (Includes JAG Luncheon)PAYMENTMerchant Fee: (2.5% added to Total Amount Due)* Price: $0.00 Total $0.00 10% Group Discount (5+ Registrations) Enter Code: 112023Payment Option Online (Pay Below) Offline (Payment by Check? Request Invoice at: info@azilg.org) Registration is completed when payment is received. Thank you! Online Payment American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Expiration Date Security Code Cardholder Name Δ
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