2014 ISPE Annual Meeting
Las Vegas, Nevada
12 - 15 October 2014
Caesars Palace
Las Vegas, Nevada
ISPE
Registration Form
PLEASE TYPE OR PRINT CLEARLY.
Full Education Delegate Fees
ISPE ID# _______________________
Type
15 September
£ First-Time Attendee £ New Member
FIRST NAME
Member
US$1,850
New Member Bundle*
US$2,119
Nonmember
US$2,225
Committee
US$1,390
Government
US$600
Student Member
US$500
Academia Member
US$1,390
Young Professional
US$1,390
*Fee includes one year ISPE Membership.
Please NOTE: No refunds after 22 September.
MI LAST NAME
INFORMAL BADGE NAME
JOB TITLE
EMAIL ADDRESS
15 September
US$2,050
US$2,319
US$2,425
US$1,590
US$600
US$600
US$1,590
US$1,590
Single-Day Education Fees (Members-Only Option)
Type
ON or BEFORE AFTER
15 September
COMPANY
CITYSTATE/PROVINCE
COUNTRY
BUSINESS TEL
EMERGENCY PHONE (for Last Minute Meeting Updates): £ CELL
PHONE £ HOME PHONE
Ways to Register:
4
ONLINE:www.ISPE.org
PHONE: +1-813-960-2105
FAX: +1-813-264-2816
MAIL:
ISPE, 600 N Westshore Blvd, Suite 900,
Tampa, FL 33609-1114, USA
A La Carte Event Fees (items below are not
included in registration fee)
Attendee
plus Guest
Event Type
Sunday Night Welcome Reception
Monday Charity 5K Run/Walk
Monday Lunch
Monday Young Professionals Networking Event
Tuesday Membership Awards Ceremony and
Luncheon
Tuesday Night Party
Wednesday Brunch
Golf Tournament
#
Hoover Dam Tour
TOTAL
PAYMENT METHOD:
Registrations require payment attached
Fee
US$0
US$25
US$65
US$50
US$70
US$225
US$60
US$135
(club rental
US$50)
US$50
Fees are based on per-person pricing. If you are invitng a guest please list name below
and add to the count in the atteedee plus guest column. and adjust pirce accordingly.
Check enclosed payable to ISPE # __________________
in the amount of $ __________________ (Must be drawn on a US bank)
Bill credit card (check type): £ VISA £ Mastercard £ American Express
CARD NUMBER 15 September
Sunday or Wednesday 1/2 day* US$300
US$350
Monday or Tuesday*
US$615
US$715
1-day (does not include night
events)
*One day choice – Sun or Mon or Tues or Wed.
Please NOTE:
• The Tuesday Night Party is not included, but may be purchased a la carte.
• No refunds after 22 September.
BUSINESS ADDRESS
ZIP+4/POSTAL CODE
ON or BEFORE AFTER
EXP. DATE
NAME OF CARDHOLDER (AS IT APPEARS ON CARD)
Guest Name_ ___________________________________________
Registration is confirmed only when payment is received.
To wire payment in U.S. Dollars:
Wells Fargo Bank NA
San Francisco, CA USA
ISPE Acct #2000027075566
ABA #121000248
CARDHOLDER SIGNATURE
Questions?
Contact ISPE Member Services at ask@ISPE.org or
+1-813-960-2105.
FEI#59-2009272