Association for the Promotion of Campus Activities

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REGISTER HERE FOR ALL OF OUR UPCOMING CONFERENCES & WORKSHOPS

LET'S GET STARTED...

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Registering For:

Contact Information

School Name:

Advisor:

Title:

Address:

City:

* State: * Zip: *

Phone:

Fax:

Email:

Organizational Facebook Page:

www.facebook.com/

Organizational Twitter:

www.twitter.com/

Co-op buyer:

Co-op Buyer Email:

Student Co-op buyer:

Student Co-op Buyer Email:

Referred By:

School Information

Student Population:

Demographics:

Programming Budget:

% of Budget Spent on:

Comedy:	%
Movies:	%
Lectures:	%
Novelities:	%

Delegate Information

APCA INTERNS: If any of the below delegates are interested in interning at the conference/workshop you are registering for, then check the YES box next to each interested delegate. Click here for the APCA Intern requirements before checking yes. We like to recognize the interns in the conference pogram, please email jess@apca.com your school/board logo.
(List additional delegates separately)

Delegates:
NOTE: All schools registering delegates must be APCA members in good standing or must pay non-member prices.

	Yes Intern	If Yes DAY PASS WHICH DAY?	Delegate's Name	Delegate's Email	I am
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#2
#3
#4
#5
#6
#7
#8
#9
#10
#11
#12
#13
#14
#15

T-shirt Sizes:

Please calculate the total number per size of t-shirts needed for your delegates:

	Small
	Medium
	Large
	XL
	XXL

Meals:

Please let us know the number of special meals you need for your delegates.

# of Vegetarian Meals:
# Non Dairy Meals:

Membership Information View APCA Membership Policies

Choose One:

I am already a member in good standing
Campus Membership Fees ($299 Annually)
Registering as a Non-Member

# of Memberships at $299:

Qty: Membership Cost: $

Total Cost

Total Membership Cost:

Total Delegate Cost:

Total Day Pass Fee(s):

Day Pass Qty:

Total Spousal Fee(s):

GRAND TOTAL:

Payment Information *

How Do You Wish To Pay?

Card Type:	*
Card Number:
Exp. Date:	/ *
CVV2:	* What is a CVV2 Number?
Name on card:	*

Billing Information *

NOTE: Please fill out your billing address regardless of your payment method.

Billing Address:

City, State:

, *

Zip:

Applicant acknowledges that the above information is true and that they have authorization to use above credit card to charge or bill for check. Delegate fees are non refundable, but a $75 credit per canceled delegate towards your choice of another APCA conference is allowable in event of cancellations (good for one year from ending date of canceled conference).

This box must be checked in order for the application to be accepted.

Security Code *

Please retype the below security code:
wz7wb

APCA Contact Information: Phone: 1-800-681-5031 • Fax: (865) 908-7104

Mailing Address:
APCA
P.O. Box 4340
Sevierville, TN 37864