ASWM Symposium Registration
by Credit Card


Step 1: Attendee Information      (* = Required Field)
Salutation:
(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 2017 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.)
 
    Lodging for the symposium:
        (Overnight guests for group events at Pendle Hill do not make their own reservations.)
 
             Will you need overnight lodging at Pendle Hill? Yes No *
 
  Choose from below, as appropriate:

Double Room:

  • Yes No Friday night March 24th Double --- $65
  • Yes No Saturday Night March 25th Double --- $65
Single Room:
  • Yes No Friday night March 24th Single --- $85
  • Yes No Saturday Night March 25th Single --- $85
Roomate:
  • Yes No I need a roommate, please pair me up!
  • Yes No I will be rooming with
 
    Meals:
    Lunch, Dinner and refreshments will be provided for all conference guests on Saturday, March 25th. Breakfasts are included for all overnight guests each morning.
  Meal Preference:
 
  •  No Preference
  •  Vegan
  •  Vegetarian
  Please choose any OPTIONAL meals you would like to add:
  •  Yes  No  -  Saturday Morning Breakfast for Commuters --- $6 (Served 8-9am Main House)
  •  Yes  No  -  Friday Night Dinner --- $13.75 (Served 6-7pm Main House)
  •  Yes  No  -  Friday Night tea/coffee service --- $3.50 (Served through the evening in Brinton House)
  •  Yes  No  -  Sunday Lunch --- $13.75 (Served 12 noon Main House)
  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. We do create a participant's 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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