Conference Registration Form - Submit by March 14

222^nd Conference of the Two-Year College Chemistry Consortium
Valencia College
March 29-30, 2019

Conference site: 1800 S Kirkman Rd, Orlando, FL 32811

Please note that your registration is not complete until your payment is received. Payment must be received by March 14, 2019 to reserve your meals. Email Kelsey Bryceson: kbryceson@valenciacollege.edu if you have registered after March 14 and your check is in the mail or you will be bringing your check to the conference.

Attendance:	Friday Saturday
Conference Registration Fee (select one):	Full-time Faculty ($50) + New membership fee ($25) = $75 Part-time Faculty ($25) + New membership fee ($25) = $50 Student, high school teacher - FREE
Meal Options:	Friday Lunch - $15 Friday Banquet - $40 - Plus Guests Saturday Lunch - $12 Vegetarian/vegan/gluten free
Trip to Universal Studios:	Click here for info and registration
Pay by:	Online By check

Personal information

Current Memberships:	ACS DivCHED
I teach at a:
First Name:	*
Last Name:	*
Institution:	*
Address 1:	*
Address 2:
City:	*
State:	Zip: *
Work Phone:	Ext:
E-mail:	*
Login Information
Username:	*
Password:	*
Confirm password:	*

Privacy Policy:
The 2YC3 lists current dues-paying members on the 2YC3 website.
The list includes names, institutional affiliation, and membership expiration date only.
Email addresses and phone numbers are NOT listed.
Yes, include my name No, do NOT include my name

Email Use Policy:
Giving 2YC3 consent for the use of your email address will allow us to send you relevant information via email.
Your email address will not be distributed to third parties.
Yes, I would like to receive emails from 2YC3 No, do NOT send me emails