Session Options

1. *Options:
   • Overnight Package ~ Single Occupancy($305)
   • Overnight Package ~ Double Occupancy($255)
   • Two Day Package (no overnight lodging)($215)
   • One Day Package (no overnight lodging)($130)

2. Payment is at time of registration. A cancellation within 14 days of event start is non-refundable.

3. Late Registration Fee of $25 to be assessed if registration received after June 1, 2013.
4. *First Name:
5. *Last Name:
6. *Male/Female:
   • Male
   • female
7. *Address:
8. *City:
9. *State:
   ---------------AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of CoumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
10. *Zip:
11. *Telephone:
12. Cell Phone:
13. E-Mail:
14. *Certifications (Please select one and input additional certifications required below):
    • NATA-BOC Contact Hours
    • NSCA CEU's
    • None
15. Additional Certifications:
16. Roommate Preference (if applicable):

17. Providing Insurance Information Below is Optional

18. Insurance Holder:
19. Medical Insurance Carrier:
20. Policy Number:
21. *Payment Options:
    • Credit/PayPal
    • Check
    • Cash

By clicking on the submit button below, you certify that you have read and agree to the Participant Agreement.

22. *Please click this option to agree to the Participant Agreement:
    • I Agree