2024 CTSRC Symposium Registration

Personal Information
Name*
First Last
Are You an AARC Member?*
- I am an AARC member
- I am not an AARC member
AARC Number
Mailing Address*
Street Address Address Line 2 City State ZIP Code
Phone
Email*
Enter Email Confirm Email
I give the CTSRC permission to advocate on my behalf.*
- yes
- no
By choosing yes, you are giving the CTSRC the ability to use your information for any local or AARC PACT events.
Employment Information
Facility or School*
Job Function*
if other, If other, identify your employment status or position.
AARC Member Registration Quantity
Price: $145.00
Non AARC Member Registration Quantity
Price: $170.00
AARC Student Member Registration Quantity
Price: $80.00
Total
$0.00
Refund Policy*
Due to the upfront costs of the event, we are unable to issue a refund if you need to cancel.
- I have read the refund policy.
Payment Choice
When you click REGISTER NOW, you will be directed to the PayPal site to complete your transaction. Payment can be made using a credit card OR Pay Pal account.
Checks must be mailed to:

CTSRC Treasurer

15 Heath CT

Cheshire, CT 06410

Checks must be received 2 weeks before the event (April 1) to be valid.
Email
This field is for validation purposes and should be left unchanged.

Personal Information