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EPA 2021 Virtual Convention Registration Form
Contact Name
*
First
Last
Contact Phone
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Contact Email
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Enter Email
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Publication Title
If you are representing a publication, enter the title. Otherwise, leave blank.
Organization/Company
The organization or company you represent. If none, leave blank.
List Each Person Registering
*
This list must include each person, including yourself if applicable, who is registering for the convention. Email addresses must be included and must be unique to each person. Click the plus sign to add more lines (max. 15).
First Name
Last Name
Email Address
Job Title
Are you an EPA member?
*
If you are representing a publication or organization, is the publication or organization a current EPA member? If you represent yourself as an individual, are you a current EPA associate member?
Yes
No
Total Number Registered (Member)
*
Please choose the total number of people registered above.
1 registration - $129
2 registrations - $258
3 registrations - $387
4 registrations - $516
5 registrations - $645
6 registrations - $645
7 registrations - $645
6 registrations - $645
9 registrations - $645
10 registrations - $645
11 registrations - $645
12 registrations - $645
13 registrations - $645
14 registrations - $645
15 registrations - $645
Total Number Registered (Non member)
*
Please choose the total number of people registered above.
1 registration - $179
2 registrations - $358
3 registrations - $537
4 registrations - $716
5 registrations - $895
6 registrations - $895
7 registrations - $895
6 registrations - $895
9 registrations - $895
10 registrations - $895
11 registrations - $895
12 registrations - $895
13 registrations - $895
14 registrations - $895
15 registrations - $895
Promo Code
If you have a promo code, enter here.
$50 Discount
$50 Discount
MTI International Discount
MTI $80 Discount
MTI US Discount
MTI $40 Discount
HACWN Discount
HACWN $50 Discount
Total
$0.00
Credit Card
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American Express
Discover
MasterCard
Visa
Card Number
Expiration Date
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
Security Code
Cardholder Name
Credit Card Billing Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Réunion
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
POLICIES AND CONDITIONS: By submitting this registration form, you are agreeing to the following:
CANCELATION POLICY: Cancelations by April 23, 2021, will receive a full refund. There will be no refunds after April 23, 2021.
CONTACT CONSENT: By registering for this event, you agree to be contacted by EPA with important information about this event and by its sponsors. You will have the option to unsubscribe at any time.