APIC | San Diego Chapter

TESTING - 2024 Fall Conference Participant Registration Form (1)

Participant Registration for this event

"*" indicates required fields

Name*

First Last

Where do you work?*

What is your title?*

Are you an APIC member?*

Yes

Are you an APIC Chapter member?*

Yes, I am a member of San Diego & Imperial County Chapter

Yes, I am a member of another Chapter

Lunch Plate Selection*

Seared Statler Chicken (mushroom prosciutto ragout | baby carrots | fingerling potatoes | asparagus | fresh herb velouté )

Roasted Vegetables with Couscous (in a puff pastry bundle | pesto oil and balsamic reduction)

Email*

Enter Email Confirm Email

Registration & Payment Options*

Paypal/Credit Card for $1

My company or I will mail a check $120

There is a 200-person capacity for this event. First come, first served by registration and payment received. Checks must be received 10 days from registration date. Refunds will be offered if requested before September 10, 2024 12:00am PST. No refunds will not be offered thereafter. Please mail check by September 1, 2024: SDIC Treasurer 1055 Tourmaline St. San Diego, CA 92109

Product Name

Price: $90.00

Total

Payment Method

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Comments

This field is for validation purposes and should be left unchanged.

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TESTING - 2024 Fall Conference Participant Registration Form (1)

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