Calendar of Events

Please fill out the following form to pay for your conference entrance 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 buffet style breakfast and Lunch Selection Provided by Sweet Tomatoes Catering.

Conference Fees:

Please select one of the Conference Payments Options below. PRO Member (includes light Breakfast, Lunch, and Seminars).... $55.00

Non Member (includes light Breakfast, Lunch, and Seminars)..... $70.00

Group Rate (For groups of 5 or more persons)..............................$60.00 per person

Hospitality Night - $15.00: Friday, March 2nd- Includes Dinner and 2 hour workshop. This covers the main applicant only. If choosing group rates, each additional attendee in the group (If attending) will be asked to pay $15.00 each for of the members at the door on hospitality night.

Membership Dues:

Is this a renewal?	Yes No
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, and listing of name on website.

Silver Membership Dues- $45.00 Benefits include Chapter Meetings, Quarterly Newsletter, one admission to the PRO Conference at the member price, listing of name on 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, listing of name on 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.

Please enter the number of employees you wish to include in your gold membership.

Employee Membership - $25.00 each. Benefits include all Chapter Meetings and one admission to the PRO Conference at the member price.

Total $-For the Gold membership and additional employees. Conference fees not included in this total.


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

Calendar of Events

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2012 - Conference Registration Form