16th AFS Texas Chapter Regional Conference Online Registration Form

Corporate Sponsorship Levels:
Underwriter ($5,000)
Platinum ($2,500)
Gold ($2,000)
Silver ($1,000)
Bronze ($500)

Individual Registration:
Full Conference:
Members $650
Non-Members $725 

Golf Cost:
Members $150
Non-Members $200

Sessions Cost:
Members $200
Non-Members $300

All Social Events Cost:
Members $350
Non-Member $425

Circle-R-Ranch Only:
Members $225
Non-Members $275

Saturday Panel:
Members $75
Non-Members $100

Session Information

8:30 AM Session
Regulatory -- Tracey Wallace, Jackson Lewis P.C.
Technical -- Randy Sandstrom, Technical Service Manager, ASK
10:30 AM Session
Regulatory -- Kartin Schatz, Jackson Lewis P.C.
Technical -- Stan Forehand, Technical Service Manager, HAI
1:30 PM Session
Regulatory -- Brad Baker, Director of Membership, NAM
Technical -- Bob Pischel, Product Manager, Foseco
3:30 PM Session
Regulatory -- Stephanie Salmon, Vice President Government Affairs, AFS
Technical -- Ben Thomas, Vice President of Sales, Tinker Omega

The following form will walk you through the registration process.  We have received feedback that some people are having problems using/submitting the online registration form.  If you have any problems using this form, please contact us  or call (903) 872-6571 and request help registering for AFS Texas Regional.  Once you complete the form our system will email you a confirmation as well as notify us that you've registered.  Within 48 hours you should receive an additional email from PayPal with an invoice.  You may pay the invoice online with credit card or by sending a check to the address listed on the invoice.  If you have not received any confirmation or invoice, please be sure to check you SPAM folder or contact you IT support regarding SPAM email.

    Are you registering for a Company or Individual?


    Contact Information (All Fields Required)

    Name

    Company Name

    Email

    Phone (numbers only, no dashes)

    Address

    City

    State

    Zip

    Individual Registration Level

    Would you like the Full Package? $650 Member / $725 Non-Member

    Golf Selection

    Are you playing golf?

    Golf Handicap (limit 25)

    Sessions

    Are you attending sessions?

    Sessions Options

    8:30 AM Session
    RegulatoryTechnical
    10:30 AM Session
    RegulatoryTechnical
    1:30 PM Session
    RegulatoryTechnical
    3:30 PM Session
    RegulatoryTechnical

    Social Events

    Are you attending social events?

    Social Option

    Saturday Panel

    Are you attending the Discussion Panel?

    Sponsorship Packages:

    Sponsorship Logo (please submit vector or PDF images)


    Note: In order to ensure your company receives proper sponsorship recognition, please have your company name/logo (as your wish it to appear on the signage) submitted on or before September 7, 2017.

    Attendee #1

    Name

    Company

    Email

    Address

    City

    State

    Zip

    Phone

    Is Attendee #1 Playing Golf?

    Golf Handicap (limit 25)
    Is Attendee #1 attending sessions?

    Sessions

    8:30 AM Session
    RegulatoryTechnical
    10:30 AM Session
    RegulatoryTechnical
    1:30 PM Session
    RegulatoryTechnical
    3:30 PM Session
    RegulatoryTechnical

    Is Attendee#1 attending social events?

    NoneAll Social EventsCircle-R-Ranch Only

    Attendee #2

    Name

    Company

    Email

    Address

    City

    State

    Zip

    Phone

    Is Attendee #2 Playing Golf?

    Golf Handicap (limit 25)
    Is Attendee #2 attending sessions?

    Sessions

    8:30 AM Session
    RegulatoryTechnical
    10:30 AM Session
    RegulatoryTechnical
    1:30 PM Session
    RegulatoryTechnical
    3:30 PM Session
    RegulatoryTechnical

    Is Attendee #2 attending social events?

    NoneAll Social EventsCircle-R-Ranch Only

    Attendee #3

    Name

    Company

    Email

    Address

    City

    State

    Zip

    Phone

    Is Attendee #3 Playing Golf?

    Golf Handicap (limit 25)
    Is Attendee #3 attending sessions?

    Sessions

    8:30 AM Session
    RegulatoryTechnical
    10:30 AM Session
    RegulatoryTechnical
    1:30 PM Session
    RegulatoryTechnical
    3:30 PM Session
    RegulatoryTechnical

    Is Attendee #3 attending social events?

    NoneAll Social EventsCircle-R-Ranch Only

    Attendee #4

    Name

    Company

    Email

    Address

    City

    State

    Zip

    Phone

    Is Attendee #4 Playing Golf?

    Golf Handicap (limit 25)
    Is Attendee #4 attending sessions?

    Sessions

    8:30 AM Session
    RegulatoryTechnical
    10:30 AM Session
    RegulatoryTechnical
    1:30 PM Session
    RegulatoryTechnical
    3:30 PM Session
    RegulatoryTechnical

    Is Attendee #4 attending social events?

    NoneAll Social EventsCircle-R-Ranch Only