REGISTRATION FORM Iowa SHRM State Conference 2015

REGISTRATION FORM Iowa SHRM State Conference 2015

Wednesday, October 7 - Friday, October 9, 2015 | Iowa Events Center, Des Moines, IA https://www.iastateshrmconference.org

First Name: Last Name:

Employer: Job Title:

Address: City:

State: ______Postal Code: ______Email address:

Business Phone: Cell Number:

Please indicate certification level(s). ð PHR ð SPHR ð GPHR ð HRM-CP ð SHRM-SCP ð sHRBP

National SHRM member? ð Yes ð No List local SHRM chapter? ð Not a local chapter member

Will you need any ADA accommodation(s)? ð Yes List accommodation(s):

Please list any special dietary needs?

Will you attend Thursday evening's Exhibitor Reception? ð Yes ð No

Select Attendance option

Full Two Day +
Pre-Conference / Full Two Day
Conference / Thursday +
Pre-Conference / Thursday,
October 8 / Friday,
October 9 / Pre-Conference Only - Oct 7
Early Bird
by 08.01.2015 / ð $425.00 / ð $365.00 / ð $300.00 / ð $235.00 / ð $150.00 / ð $99.00
Registration
by 10.02.2015 / ð $480.00 / ð $450.00 / ð $325.00 / ð $250.00 / ð $165.00 / ð $115.00
Student*
By 10.02.2015 / ð $50.00 / ð $50.00 / ð $50.00 / ð $50.00 / ð $50.00 / ð $25.00
Additional
Meal Tickets / __ x $25.00 Ea. / __ x $25.00 Ea. / __ x $25.00 Ea. / __ x $25.00 Ea. / __ x $25.00 Ea. / __ x $25.00 Ea.
Total Amount

*Students may be asked to provide a valid student I.D. to receive discount.

ð I understand I am responsible for any parking fees associated with parking ramps or other paid parking.

To register and pay by check please

1.  Complete this form

2.  Make Check Payable to: Iowa SHRM State Council Payment must be received no later than Sept 15, 2015

3.  Mail to: Iowa SHRM State Council c/o Karen Rieck P.O. Box 3675 Urbandale, IA 50323

4.  An email confirmation of registration will be sent within 7 days of receipt

Questions regarding the conference, hotel accommodations, speakers, etc… may be directed to: