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Online Registration
Register for 71st Annual Convention
First Name:
Last Name:
Email Address:
Address:
City:
State:
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If somebody else is paying for your registration (e.g. your vocational rehabilitation counselor), please list his/her name or agency.
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Item
Quantity
Additional Information
Totals
Registration - $ 25.00
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10
If registering more than one person, enter others' names, one per line:
$ 0.00
Banquet Ticket - $ 40.00
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10
$ 0.00
Grand Total: $