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