ASWM Event Registration
by Credit Card

Step 1: Demographic Information      (* = Required Field)
(e.g. Dr., Prof., Ms., Mr., Dean...)
First Name: *
Middle Name or Initial:  
Last Name: *
Address: *
City: *
State: *
Zip Code: *
Country: *
Phone: *
Email: *
Confirm Email:   *
Other Information:
    Please select from one of the following ASWM membership categories: *
  A current ASWM member. (I have paid my 2018 dues on the ASWM website)
  Past ASWM member but need to renew for the current year and pay my dues now.
  Not an ASWM member but would like to join now and pay my dues with my registration.
  Not interested in joining. I am paying non-member registration rates.
    I am making a presentation at the symposium:
        (All presenters must become members.)

Yes No *
    Full Name: *
(As I prefer it on my name badge.)
I would like to go on the tour of 'The Temple of Goddess Spirituality Dedicated to Sekhmet' scheduled for Thursday, March 16, 2018, 5:00 - 9:00 PM, Cost $35

Yes No *
    Meals: Morning coffee/tea service and lunches on both days are included in the registration price.

Please select a meal option:

    Other: Please let us know of any specific physical or dietary limitations:
    Networking & Contact Info: ASWM does not sell or share our membership list with outside entities. However, we do create a participants list.

May we include your name and contact information? Yes No *

    Special Instructions:   
ASWM accepts Visa, Mastercard, Discover & American Express.

Read This Before You Proceed:

Credit Card Charges Statement: Your Credit Card Statement will show any charges associated with ASWM as charged from:

Earthcare Technologies, Inc.

I have read & understand the above statement.   *

Earthcare is our internet registration service provider.


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