68th Annual Human Resources Management Conference Participant Registration Form

Program #CS-2210-HRM-01

Printable Form – Please use your browser’s Print icon to print

Mail To:
Registration Services

The University of Alabama
Box 870398
Tuscaloosa, AL 35487

Please submit this entire page for your registration. For multiple registrations, please duplicate this form.

[ ]Mr. [ ]Ms. [ ]Dr. First:____________________________Middle Initial:________Last:____________________________

Preferred Name/Nickname:____________________________

Company/Organization Name:____________________________

Mailing Address:____________________________City:____________________________State:________Zip:______________

Email Address:____________________________Phone:____________________________

Job Title:____________________________

[ ] Enclosed is a check for $____________________________ made payable to THE UNIVERSITY OF ALABAMA

[ ] Purchase order is attached.

[ ] Charge $____________________________to credit card: [ ] MasterCard [ ] VISA [ ] American Express [ ] Discover

Card #____________________________Exp. Date (M/Y)____________________________

Security / Verification / CVV Code____________________________(Three or four digit code on back or front of credit card.)

Authorizing Signature:____________________________

APPLICABLE FEES:

Please indicate the type of your attendance: [ ] In-Person [ ] Virtual

Program #CS-2210-HRM-01

[ ] $275 Early Bird Conference Registration (DEADLINE 8/19/2022)

[ ] $325 Standard Conference Registration (BEGINS 8/20/2022)

[ ] $275 UA Employee Registration

[ ] $99 Student Registration *must provide documentation

[ ] I will be attending the Reception (4:45 PM – 6:00 PM)

Group Rates:
Register 2, get the 3rd registration free! Registrations must be submitted at the
same time

[ ] $325 Group Rate Registration

Note: The University of Alabama is committed to complying with the Americans with Disabilities Act. Requests for accommodation of physical and/or dietary needs should be made at least 30 calendar days in advance of the program date. Please email your request to christina.barnett@ua.edu. A portion of the invoice amount for this program will go to the Capstone Lifelong Learning Foundation to support activities of The University of Alabama and the College of Continuing Studies. Need our STAARS Vendor Number? Please use VC000118827 for UA College of Continuing Studies.