Register Your Way
Click: http://ispe.org/2016-aug-tampa-training
Fax: +1-813-264-2816
Mail: ISPE
600 N. Westshore Blvd. Suite 900
Tampa, FL 33609
Call: +1-813-960-2105
Email: ask@ispe.org
ISPE Training Institute Registration Form
August 2016 Courses
ISPE Training
600 N. Westshore Blvd, 9th Floor
Tampa, FL 33609
HOW TO REGISTER
Registration fees include course materials, refreshment breaks and lunches. Hotel accommodations and hotel fees are
separate.
First Time Attendee ______
New Member _____
ISPE ID #
Check here if you were previously an ISPE Member ________
First Name
MI
_Last Name
Informal Badge Name
Chapter/Affiliate
Job Title
Email Address
Company
Business Address
City
State/Province
Business Tel.
Zip+4/Postal code ________Country____________
Business Fax
Emergency Phone for last minute meeting updates
or Home Phone ______________
I wish to keep my data confidential and it is given only for use by ISPE and its local Chapters and Affiliates _________
(This will exclude you from the conference Attendee Listing, Member Directory and Exhibitor Listing.)
Use the Early Bird Promo Codes at checkout to receive a $200 discount, if you register on or before the
expiration date.
New Member*
(Includes 1 year
membership)
Member
Early Bird Promo Code:
T10T40AUG2016
T10
8-9 Aug
OSD
Early Bird Promo Code:
T46AUG2016
T46
22-24 Aug
Process
Validation
Non-Member
Early Bird
Expires 11 Jul
After
11 Jul
Early Bird
Expires 11 Jul
After
11 Jul
Early Bird
Expires
11 Jul
After
11 Jul
$1,700
$1,900
$1,984
$2,184
$2,085
$2,285
Jul
Early Bird
Expires 25 Jul
After
25 Jul
Early Bird
Expires
25 Jul
After
25 Jul
$2,350
$2,434
$2,634
$2,560
$2,760
Early Bird
Expires 25 Jul
$2,150
After
25
Government
Total US $
$850
$1,075
*For Government rates please contact Member Services at 813-960-2105 or email ask@ispe.org
Special Requirements: If you require special accommodations to participate, provide a written description with your
registration form and contact member services or email ask@ispe.org with questions. For details on group discounts,
contact ISPE Member Services.
SPECIAL LUNCH REQUIREMENT** (Vegetarian, Kosher, Gluten Free, Allergy) – Please Specify ______________ **
Additional fee may apply
PAYMENT METHOD — REGISTRATIONS REQUIRE PAYMENT ATTACHED
Page 1 of 2
Substituting for
Promo Code___________________
(NONMEMBERS SUBSTITUTING FOR A MEMBER MUST PAY THE DIFFERENCE IN FEES)
Check enclosed payable to ISPE # _____________in the amount of $_______________ (MUST BE DRAWN ON A
US BANK)
Bill credit card (Check type): VISA ______
MC______ AMEX______
Card number
Exp. date ___________Security Code _____________ (on back of
card)
Name of cardholder ____________________________________________________ (AS IT APPEARS ON CARD)
Cardholder signature
Cancellations, Substitutions or Transfers - Cancellations must be made in writing and received by ISPE prior to the
start of the training course. If cancellations are received one month prior to the start date of the course, a full refund,
minus a $100 handling fee will be issued. After that time, no refunds will be granted. If you are unable to attend, a
substitution will be accepted, though nonmembers substituting for a member must pay the difference in fees prior to
the start of the event. Please visit http://ispe.org/2016-aug-tampa-training to view the complete registration and
cancellation policies. By registering for this event, I grant ISPE permission to record and/or copy my image and the
right to use these images for ISPE promotional purposes. If not, please inform ask@ispe.org
Page 2 of 2