Provider Resource Organization

Calendar of Events

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2010 - Conference Registration Form


Please fill out the following form to pay for your conference entrance and choose your lunch selection and optionally pay for a one year membership or renewal in Provider Resource Organization. No Children Please.

REQUIRED INFORMATION

 

First Name:

 Enter Your First Name.

Last Name:

 Enter your Last Name.

Phone Number:

 Enter Your Phone Number.Invalid format.

Email:

 Email is Required.Invalid format.

Street Address:

 Address is required.

City:

 City is required.

State:

 Please select a state.Please select a state.

Zip:

 Zipcode is required.Invalid format.

 

Conference Lunch Selection Provided by Catherine’s Catering

Please check only ONE selection.

Please select one of the lunch options below.



Schwan’s has generously donated the Desserts.

Conference Fees:

Please select one of the Conference Payments Options below.




Hospitality Night - $5.00: Friday, March 12th - Includes Dinner and 1 hour Training. This covers the applicant only. If choosing group rates, each additional attendee in the group (If attending) will be asked to pay $5.00 each at the door on hospitality night.


Membership Dues:

Is this a renewal?


If so, what Pro Chapter:

I do not want to pay for membership dues at this time.
Bronze Membership Dues- $35.00 Benefits include Chapter Meetings, Quarterly Newsletter, one admission to the PRO Conference at the member price, Lending Library, and listing of name in newsletter & website.

Silver Membership Dues- $45.00 Benefits include Chapter Meetings, Quarterly Newsletter, one admission to the PRO Conference at the member price, Lending Library, list of name in newsletter & website, 25% discount on a rental of a PRO conference vendor table, and hyperlink to your business website and/or email address on the PRO website.

Gold Membership Dues- $70.00 Includes one employee membership and other benefits include Chapter Meetings, Quarterly Newsletter, one admission to the PRO Conference at the member price, Lending Library, list of name in newsletter & website, 25% discount on a rental of a PRO conference vendor table, and hyperlink to your business website and/or email address on the PRO website.



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Please enter the letters above into the box above and then click REGISTER NOW to continue: