2015 NASPSPA Conference Registration (June 4-7, 2015) Portland Hilton & Executive Towers (Conference Starts on Thursday am) Fax completed form to secure fax line: 217-351-1549 First Name_________________________Last Name _______________________________ University or Affiliation __________________________________________________________ Mailing Address ____________________________________________________________________________________ City____________________________State/Prov______________Zip/Postal_____________ Country ______________Phone ________________ Email __________________________ CONFERENCE REGISTRATION FEE (IN $US) – Note you must be a member to register. Professional Student Retired By April 1 By May 15 After May 15 & On Site $320 $350 $390 $180 $220 $280 $180 $220 $280 Pre-Conference Workshops on Wednesday, June 3 Workshop 1 Cost: $15, 2:30-6:30 pm. Part 1 introduces factor analysis and structural equation models. Part 2 addresses advanced issues in structural equation modeling. Presenters: Brian French, Washington State Univ. and Holmes Finch, Ball State Univ. Attend? Yes No Workshop 2 Cost: $15, 2:30-5:30 pm. Strategies for securing external grant funding, with emphasis on mid (or late)-career scholars without a previous grant track record. Attend? Yes No Thursday night Happy Hour/Reception (one ticket is provided with your registration) How many extra tickets do you need ($15)? ____ Friday Awards/Business Luncheon (one ticket is provided with your registration) Attend? Yes No Saturday Night Dinner Party/Banquet (one adult ticket is provided with your registration) MUST ANSWER: Will you attend? Yes No # of extra adult tickets needed ($50)? ___ How many child tickets (under 12 years old) do you need ($20)? ____ Student Events: Thursday Lunch Student-Faculty Roundtable: Will you attend? Yes No # tickets? ($10) ____ Friday Night Student Social: Will you attend? Yes No # tickets? ($10) ____ Questions: Is this your first time attending the NASPSPA annual meeting? Yes No How would you like your name to appear on name badge? ___________________________________ How would you like your institution/affiliation to appear on name badge?________________________ Do you require a vegetarian or gluten free meal for provided meals? Gluten Free Vegetarian Would you like a printed copy of the 2015 abstract supplement (an e-version is provided free) at $10? Payment Summary: Registration Fee (fill in amount from table above) Workshop 1: Statistics ($15) Workshop 2: Grant Funding ($15) Happy Hour/Reception Extra Ticket ($15 each) Saturday Night Dinner Party Extra Adult Ticket ($50 each) Saturday Night Dinner Party Child (under 12 years old) Ticket ($20 each) Student-Faculty Roundtable Tickets ($10 each) Student Social Tickets ($10 each) Printed copy of 2015 abstract supplement ($10) – free e-version available) Total $_________ $ _________ $ _________ $ _________ $ _________ $ _________ $ _________ $ _________ $ _________ $ _________ Circle Credit Card Type: MC Visa AmEx Card Number ___ ___ ___ ___ - ___ ___ ___ ___ - ___ ___ ___ ___ - ___ ___ ___ ___ Card Holders Name _____________________________________ (Please print) Exp: _________