2012 CONFERENCE REGISTRATION

Register SOON --- space for this exciting conference is limited!

Please note: REGISTRANTS MUST MAKE THEIR OWN HOTEL ACCOMMODATIONS. Reservations will NOT be made by the Conference Committee.

LAST Name


FIRST Name


Title [use n/a, retired or in-transition as needed]


Company [use n/a, retired or in-transition as needed]


Size of company
n/a    Less than 50    51 - 249    250 - 999    1000 - 4999    5000 - 9999    10000 or more   

Street Address


City


State
NC    SC    Other   

Zip Code


Phone [area code - exchange - number - extension, if any]


Email


Name on Badge


Professional Certification
PHR    SPHR    Other    None   

Local HR/SHRM Chapter affiliation:


EARLY BIRD REGISTRATION FEE = $175.00 if payment received by April 13, 2012. After that date, regular registration of $210.00 will apply. If paying by check or money order, please remit to: Carolinas’ HR Conference, P.O. Box 6147, Winston-Salem, NC 27109-6147.

If paying online by credit card or PayPal, you will be able to handle the transaction after you hit SUBMIT at the end of this form.

NOTE: The registration fee is non-refundable after April 22, 2012. I will pay by:

Credit card or PayPal that is registered in MY NAME
Credit card or PayPal that is registered to SOMEONE ELSE
Mail
I am a 2012 Conference Speaker - fee is waived
I am a 2012 Conference Sponsor - fee is waived

IF you indicated that you were PAYING BY CREDIT CARD that is REGISTERED to SOMEONE OTHER THAN YOU, please enter that person’s NAME. IF this question does NOT APPLY to you, just enter N/A. YOU MUST ANSWER THIS QUESTION.


How did you hear about the Carolinas’ Human Resources Conference?


How many years have you been attending the Carolinas’ HR Conference?
1 - 5 years    6 - 10 years    11 - 15 years    16 - 20 years    21 - 25 years    More than 25 years   

Why have you chosen to attend the conference(s)?
Cost
Good for my HR career
HRCI credits
Location
Networking opportunities
Speaker(s)

If you elected to mail your payment, please PRINT THIS PAGE NOW and include a copy of it with your payment.

If you have selected to pay online, you will be able to make a secure, online payment after you hit SUBMIT below.

****************************************************************************************************************************************************************