SEDA 2016 Annual Symposium Registration – Bonita Springs, FL – June 2016 "The Sun Never Sets on Membranes"Hyatt Regency Coconut Point Resort & SpaBonita Springs, FLJune 5-8, 2016 RegistrantSalutation*Mr.Mrs.Ms.Dr.First Name*Last Name*Company*Job Title*Address*City*State*Zip/Postal Code*Country*Telephone*CellFaxEmail* Email Notifications*Yes, I authorize receiving publication email notificationsNo, I would not like to receive publication email notifications (opt-out)Authorization for receiving publication email notification from SEDA. (applies to all email addresses on this form)Website License #License StateLicense TypeLicense Grade Special Needs Food Allergies (describe in comments) Gluten Free Meals Halal Meals Vegan Meals Vegetarian Meals Wheelchair Access Other (describe in Comments) Member SEDA AMTA (check all that apply) Event RegistrationMust be an active member of one of the organizations listed above in order to quality for Member/Affiliate rate. Early Registration applies to submissions on or before May 9, 2016.Event Sponsor*Platinum Sponsor, $1,500Gold Sponsor, $1,250Silver Sponsor, $1,000No SponsorshipSponsorship are available to members in good standing.Exhibit Space*Table Top Exhibit (Includes 1 Attendee), $750Trailer Space Exhibit (limit 3) (Includes 1 Attendee), $750No ExhibitMust be a Div 1 or Div 2 member to exhibit.All Exhibit Spaces will be Selected on a First Come/First Served Basis at the Time of Registration and Payment in Full.Registration*Full Symposium - Members/Affiliates, $425Full Symposium - Non-Member, $475Full Symposium - Full-Time Student/Retired (Must submit Student ID w/registration), $275One Day Only - Monday, $275One Day Only - Tuesday, $275One Day Only - Wednesday, $275Cannot Attend Workshop - Purchase Materials Only, $30CEUs/PDHs included in registration feeSponsorship Package: Your Choice*Exhibit PackageIncludes 1 Attendee with Table-Top Exhibit2 Full AttendeesIncludes 1 Additional Full Attendee RegistrationExhibit Space*Table-Top ExhibitTrailer Space Exhibit (Trailer length must be 24' or less)Included in the sponsorship package.Symposium Attendee?*Yes, Same as aboveNo, Different from above Included Registrant 1Attendee different from above.Salutation - Included Registrant 1*Mr.Mrs.Ms.Dr.First Name - Included Registrant 1*Last Name - Included Registrant 1*Company - Included Registrant 1*Job Title - Included Registrant 1*Address - Included Registrant 1*City - Included Registrant 1*State - Included Registrant 1*Zip/Postal Code - Included Registrant 1*Country - Included Registrant 1*Telephone - Included Registrant 1*Cell - Included Registrant 1Email - Included Registrant 1* License # - Included Registrant 1License State - Included Registrant 1License Type - Included Registrant 1License Grade - Included Registrant 1 Included Registrant 2Salutation - Included Registrant 2*Mr.Mrs.Ms.Dr.First Name - Included Registrant 2*Last Name - Included Registrant 2*Company - Included Registrant 2*Job Title - Included Registrant 2*Address - Included Registrant 2*City - Included Registrant 2*State - Included Registrant 2*Zip/Postal Code - Included Registrant 2*Country - Included Registrant 2*Telephone - Included Registrant 2*Cell - Included Registrant 2Email - Included Registrant 2* License # - Included Registrant 2License State - Included Registrant 2License Type - Included Registrant 2License Grade - Included Registrant 2 Exhibit SpacePlease select your choices for the exhibit space.Full payment must be made by March 31, 2016 or deposit and booth space will be forfeited.Click image to view layout 3 trailer spaces available. Location to be determined. Exhibit Space Number: First Choice*1 - N/A Sold2 - N/A Sold3 - N/A Sold45 - N/A Sold67 - N/A Sold8 - N/A Sold910 - N/A Sold11 - N/A Sold12 - N/A Sold1314 - N/A Sold15 - N/A Sold1617 - N/A Sold18 - N/A Sold19 - N/A Sold20 - N/A Sold21222324 - N/A Sold25 - N/A Sold26 - N/A Sold27 - N/A Sold282930 - N/A Sold Exhibit Space Number: Second Choice*1 - N/A Sold2 - N/A Sold3 - N/A Sold45 - N/A Sold67 - N/A Sold8 - N/A Sold910 - N/A Sold11 - N/A Sold12 - N/A Sold1314 - N/A Sold15 - N/A Sold1617 - N/A Sold18 - N/A Sold19 - N/A Sold20 - N/A Sold21222324 - N/A Sold25 - N/A Sold26 - N/A Sold27 - N/A Sold282930 - N/A Sold Exhibit Space Number: Thrid Choice*1 - N/A Sold2 - N/A Sold3 - N/A Sold45 - N/A Sold67 - N/A Sold8 - N/A Sold910 - N/A Sold11 - N/A Sold12 - N/A Sold1314 - N/A Sold15 - N/A Sold1617 - N/A Sold18 - N/A Sold19 - N/A Sold20 - N/A Sold21222324 - N/A Sold25 - N/A Sold26 - N/A Sold27 - N/A Sold282930 - N/A Sold Exhibit Space Number: Four Choice*1 - N/A Sold2 - N/A Sold3 - N/A Sold45 - N/A Sold67 - N/A Sold8 - N/A Sold910 - N/A Sold11 - N/A Sold12 - N/A Sold1314 - N/A Sold15 - N/A Sold1617 - N/A Sold18 - N/A Sold19 - N/A Sold20 - N/A Sold21222324 - N/A Sold25 - N/A Sold26 - N/A Sold27 - N/A Sold282930 - N/A Sold Symposium ActivitiesWelcome Reception*Yes, Attending Welcome Reception - Sun., June 5th 6:30 - 8:30 p.m.No, Not Attending Welcome ReceptionGuest/Spouse Welcome Reception*Yes, Guest/Spouse attending Welcome Reception - Sun., June 5th 6:30 - 8:30 p.m., $35No, Guest/Spouse not attending Welcome ReceptionNumber of Adults attending Welcome Reception? (Guests 13 and older)Number of Children attending Welcome Reception? (12 and under are free)Networking Reception*Yes, Attending Networking Reception - Mon., June 6th 4:30 - 6:30 p.m.No, Not Attending Networking ReceptionOperator Challenge*Yes, Attending Operator Challenge - Tue., June 7th 4:15 - 4:45 p.m.No, Not Attending Operator Challenge CD or Download OptionSEDA is now offering registrants the option of downloading event PowerPoints online or receiving them on a CD.Please indicate which option is preferred:*I prefer to receive the download linkI prefer to receive the CDAttendee materials delivery email option*Yes, I would like to have the materials sent to another email addressNo, I would like to have the materials sent to the email aboveAttendee materials will be sent approx. 2 weeks after event, provide an email address compatible to receive and/or access Hightail messages.Attendee materials email address* If you prefer to an email other than listed above, provide the email address here. Total $0.00 Payment InformationPayment Method*Credit Card - Online PaymenteCheck - Online PaymentCheckInvoice CommentsIf you would like a copy of the invoice/receipt sent to another*Yes, send copy of invoice/receipt to:No, don't need a copy sentIf yes, you would like a copy of the invoice/receipt sent to another other than the attendee please enter information below.Name* First Last Email Address* Comments or Instructions Written cancellation requests received by the Southeast Desalting Association (SEDA) at least 5 days before a scheduled event will receive a refund, less a $50 administrative processing fee. Full payment is required if the request is received less than 5 days of the scheduled event and no refund will be available. A credit may be issued less a $25 recordkeeping fee towards a future event provided that it is redeemed within 12 months of the credited scheduled event. The credit will be forfeited if not used within the 12 months timeframe. A substitution of the registrant may be made any time without cost up to the date of the event. The requested amount of a refund or credit must exceed their respective administrative processing fees as described above in order to be considered. SEDA reserves the right to make changes to the scheduled event including but not limited to changing the event location, scheduled date(s), program and speakers, or to cancel the event in its entirety when conditions beyond its control prevail. If the event is cancelled, SEDA’s liability is limited to providing a full refund of the fees paid toward the scheduled event. Final Step of Application ProcessPlease enter the letters displayed below to complete your application and then click Submit.CAPTCHA
