TESTING - 2024 Fall Conference Participant Registration Form (1) Participant Registration for this event "*" indicates required fields PhoneThis field is for validation purposes and should be left unchanged.Name* First Last Where do you work?*What is your title?*Are you an APIC member?* Yes No 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 No 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) Includes: garden salad | freshly baked bread | butter | dessert | regular coffee | decaf | assorted hot teas 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 92109Product Name Price: $90.00 Total Payment MethodPayPal CheckoutCredit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name Δ