CCWC - Registration Form

Introduction
Contact Information
Seat Selection
Name Badges
Billing Information
Review

Register Online Using Your MasterCard, VISA, Discover or American Express
(Tax ID #77-0178140)

TUESDAY, SEPTEMBER 20, 2022
Fresno Convention & Entertainment Center

Ticket price of $125 includes Continental Breakfast, all Seminars, the Marketplace, Warm-Up, Keynote Luncheon with Dr. Jennifer Ashton, Cool-Down Session and Reception. All tickets purchased online are displayed including a $5 per ticket processing fee.

REGISTRATION: $130 per person including $5 processing fee (through August 12, 2022)

LATE REGISTRATION: $145 per person including $5 processing fee (beginning August 13, 2022)

Students ONLY – $80 per student including $5 processing fee (Save $50 by entering your student ID # at registration!)

CCWC and all participants will abide by COVID19 health precautions in place by local authorities at the time of the event.

The information you list below is where your conference badges will be mailed. Please include any Suite, Apt. or Mail Stop information to be sure your badges will reach you safely. Check to make sure all is correct!

*First Name
*Last Name
Company
*Street
*City
*State
*Zip
*Daytime Phone	(i.e. 559-555-1212)
*Email
If purchasing a table, what table name would you like to use?	Optional
	Check here if you are attending the conference (if you are purchasing a ticket for someone else, leave this unchecked).
	Have you attended the conference in the past 5 years?

You can purchase any combination of tickets (tables and/or general seating)

Quantity

Registration Item

Price (including $5 processing fee per ticket)

General Seating

$130 (seating will be assigned to a reserved table for the keynote luncheon)

Student Seating

$80 (seating will be assigned to a reserved table for the keynote luncheon, must have valid Student ID)

Table of 11

$1430 (Guest info will be collected later in the registration process)

As the primary contact person, all badges will be mailed to you to distribute to those attending CCWC in your group.

If members of your group would like to receive future emails regarding CCWC, please list their names and email addresses below. (This is not mandatory)

BREAKOUT SESSION REGISTRATION CHANGE:

We are no longer asking for breakout session selections prior to the conference. All seminar sessions will be available on a first-come first-served basis until the room is full per the fire marshal’s instructions. Please arrive early to avoid disappointment and make your group aware of this change. For your information and planning, breakout session titles and descriptions will be on our website: www.ccwc-fresno.org

Attendee First Name (if known)	Attendee Last Name (if known)	Attendee E-Mail (if known)

Billing Information: Please read the notices in red below. Notice: The Billing Information is only for billing the credit card. If the credit card belongs to someone else, please fill out their contact information below. If the contact and billing information is the same, check the box and go directly to the payment information. Notice: All badges for your group will be mailed to the name and address listed in the contact information (not Billing Information). It is the responsibility of the contact person to distribute the badges to your guests. Same as contact information?
*First Name
*Last Name
Company
*Street
*City
*State
*Zip
*Daytime Phone
*Email

Payment Information:

Name on Card:
* Please select one of the following:
Card Type :
Credit Card Number:
Expiration Date:	/
CVV Code:	(Security Code on back of card)

First Name:
Last Name:
Company:
Address:
City:
State:
Zip Code:
Phone:
E-Mail Address:

Items Ordered

Item	Quantity	Price

Total: $130.00

By clicking this button you understand that your credit card will be charged for the amount above including processing fees.

(Please click only 1 time and wait for a confirmation page)